Predictors of shunt dependency after aneurysmal SAH

In this retrospective analysis if 130 patients treated for ruptured aneurysms we evaluated the development of early and late hydrocephalus in regard to the possible causes. In 15 patients ventriculo-atrial shunt was implanted due to late hydrocephalus showing enlargement of the ventricular system, progressive mental disorders, positive effect of lumbar puncture and the removal of CSF. The distribution of aneurysms was not different from that of the patients without hydrocephalus. There was a correlation to the severity of the SAH as 7 patients out of those 15 were graded. Fisher 4 on admission. Furthermore, 11 out of the 15 patients had early hydrocephalus requiring external ventricular drainage. The surgical strategy, opening of the lamina terminalis, clearance of blood clots in all accessable basal cisterns was not different to the patients without hydrocephalus. During follow-up the shunt had to be removed in two patients after infection and so far there was no need to reimplant. In another two patients there was no improvement of the neurological status after the shunting procedure. Summing up the results we found a strong correlation of early and late hydrocephalus to the severity of SAH. Furthermore, the opening of the lamina terminalis and the clearance of blood from the basal cisterns seemed to have a positive effect on the development of hydrocephalus