Top

Published in:

Open Access 02-05-2023 | Addiction | Original Article

The value of ventricular measurements in the prediction of shunt dependency after aneurysmal subarachnoid hemorrhage

Authors: Maryam Said, Meltem Gümüs, Jan Rodemerk, Mehdi Chihi, Laurèl Rauschenbach, Thiemo F. Dinger, Marvin Darkwah Oppong, Philipp Dammann, Karsten H. Wrede, Ulrich Sure, Ramazan Jabbarli

Published in: Acta Neurochirurgica | Issue 6/2023

Abstract

Objective

Chronic hydrocephalus requiring shunt placement is a common complication of aneurysmal subarachnoid hemorrhage (SAH). Different risk factors and prediction scores for post-SAH shunt dependency have been evaluated so far. We analyzed the value of ventricle measurements for prediction of the need for shunt placement in SAH patients.

Methods

Eligible SAH cases treated between 01/2003 and 06/2016 were included. Initial computed tomography scans were reviewed to measure ventricle indices (bifrontal, bicaudate, Evans’, ventricular, Huckman’s, and third ventricle ratio). Previously introduced CHESS and SDASH scores for shunt dependency were calculated. Receiver operating characteristic analyses were performed for diagnostic accuracy of the ventricle indices and to identify the clinically relevant cut-offs.

Results

Shunt placement followed in 221 (36.5%) of 606 patients. In univariate analyses, all ventricular indices were associated with shunting (all: p<0.0001). The area under the curve (AUC) ranged between 0.622 and 0.662. In multivariate analyses, only Huckman’s index was associated with shunt dependency (cut-off at ≥6.0cm, p<0.0001) independent of the CHESS score as baseline prediction model. A combined score (0–10 points) containing the CHESS score components (0–8 points) and Huckman’s index (+2 points) showed better diagnostic accuracy (AUC=0.751) than the CHESS (AUC=0.713) and SDASH (AUC=0.693) scores and the highest overall model quality (0.71 vs. 0.65 and 0.67), respectively.

Conclusions

Ventricle measurements are feasible for early prediction of shunt placement after SAH. The combined prediction model containing the CHESS score and Huckman’s index showed remarkable diagnostic accuracy regarding identification of SAH individuals requiring shunt placement. External validation of the presented combined CHESS-Huckman score is mandatory.

Available only for authorised users

Bae IS, Yi HJ, Choi KS et al (2014) Comparison of incidence and risk factors for shunt-dependent hydrocephalus in aneurysmal subarachnoid hemorrhage patients. J Cerebrovasc Endovasc Neurosurg 16:78–84. https://doi.org/10.7461/jcen.2014.16.2.78CrossRefPubMedPubMedCentral

Bermel RA, Bakshi R, Tjoa C et al (2002) Bicaudate ratio as a magnetic resonance imaging marker of brain atrophy in multiple sclerosis. Arch Neurol 59:275–280. https://doi.org/10.1001/archneur.59.2.275CrossRefPubMed

Brinkman SD, Sarwar M, Levin HS et al (1981) Quantitative indexes of computed tomography in dementia and normal aging. Radiology 138:89–92. https://doi.org/10.1148/radiology.138.1.7455102CrossRefPubMed

Chen S, Yang Q, Chen G et al (2015) An update on inflammation in the acute phase of intracerebral hemorrhage. Transl Stroke Res 6:4–8. https://doi.org/10.1007/s12975-014-0384-4CrossRefPubMed

Chen Q, Feng Z, Tan Q et al Post-hemorrhagic hydrocephalus: recent advances and new therapeutic insights. J Neurol Sci 2017, 375:220–230. https://doi.org/10.1016/j.jns.2017.01.072

Chen S, Luo J, Reis C et al (2017) Hydrocephalus after subarachnoid hemorrhage: pathophysiology, diagnosis, and treatment. Biomed Res Int 2017:8584753. https://doi.org/10.1155/2017/8584753CrossRefPubMedPubMedCentral

Chung DY, Thompson BB, Kumar MA et al (2022) Association of external ventricular drain wean strategy with shunt placement and length of stay in subarachnoid hemorrhage: a prospective multicenter study. Neurocrit Care 36:536–545. https://doi.org/10.1007/s12028-021-01343-9CrossRefPubMed

Cutler NS, Srinivasan S, Aaron BL et al (2020) Normal cerebral ventricular volume growth in childhood. J Neurosurg Pediatr 26:517–524. https://doi.org/10.3171/2020.5.PEDS20178CrossRefPubMed

Czorlich P, Mende KC, Vettorazzi E et al (2015) Validation of the modified Graeb score in aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 157:1867–1872. https://doi.org/10.1007/s00701-015-2583-5CrossRefPubMed

10.

Darkwah Oppong M, Wrede KH, Muller D et al (2021) PaCO2-management in the neuro-critical care of patients with subarachnoid hemorrhage. Sci Rep 11:19191. https://doi.org/10.1038/s41598-021-98462-2CrossRefPubMedPubMedCentral

11.

Darkwah Oppong M, Steinwasser L, Riess C et al (2022) Blood pressure and outcome after aneurysmal subarachnoid hemorrhage. Sci Rep 12:8006. https://doi.org/10.1038/s41598-022-11903-4CrossRefPubMedPubMedCentral

12.

de Oliveira JG, Beck J, Setzer M et al (2007) Risk of shunt-dependent hydrocephalus after occlusion of ruptured intracranial aneurysms by surgical clipping or endovascular coiling: a single-institution series and meta-analysis. Neurosurgery 61:924–933. https://doi.org/10.1227/01.neu.0000303188.72425.24CrossRefPubMed

13.

Dehdashti AR, Rilliet B, Rufenacht DA et al (2004) Shunt-dependent hydrocephalus after rupture of intracranial aneurysms: a prospective study of the influence of treatment modality. J Neurosurg 101:402–407. https://doi.org/10.3171/jns.2004.101.3.0402CrossRefPubMed

14.

Diesing D, Wolf S, Sommerfeld J et al (2018) A novel score to predict shunt dependency after aneurysmal subarachnoid hemorrhage. J Neurosurg 128:1273–1279. https://doi.org/10.3171/2016.12.JNS162400CrossRefPubMed

15.

Dos Santos SC, Fortes Lima TT, Lunardi LW et al (2017) External ventricular drain-related infection in spontaneous intracerebral hemorrhage. World Neurosurg 99:580–583. https://doi.org/10.1016/j.wneu.2016.12.071CrossRefPubMed

16.

Erixon HO, Sorteberg A, Sorteberg W et al (2014) Predictors of shunt dependency after aneurysmal subarachnoid hemorrhage: results of a single-center clinical trial. Acta Neurochir (Wien) 156:2059–2069. https://doi.org/10.1007/s00701-014-2200-zCrossRefPubMed

17.

Evans WJ (1942) An encephalographic ratio for estimating ventricular enlargement and cerebral atrophy. Arch Neurol Psychiatry 47:931–937CrossRef

18.

Garcia-Armengol R, Puyalto de Pablo P, Misis M et al (2021) Validation of shunt dependency prediction scores after aneurysmal spontaneous subarachnoid hemorrhage. Acta Neurochir (Wien) 163:743–751. https://doi.org/10.1007/s00701-020-04688-wCrossRefPubMed

19.

Graeb DA, Robertson WD, Lapointe JS et al (1982) Computed tomographic diagnosis of intraventricular hemorrhage. Etiology and prognosis. Radiology 143:91–96. https://doi.org/10.1148/radiology.143.1.6977795CrossRefPubMed

20.

Hahn FJ and Rim K. Frontal ventricular dimensions on normal computed tomography. AJR Am J Roentgenol 1976; 126: 593-596. 1976/03/01. https://doi.org/10.2214/ajr.126.3.593.

21.

Hijdra A, Brouwers PJ, Vermeulen M et al (1990) Grading the amount of blood on computed tomograms after subarachnoid hemorrhage. Stroke 21:1156–1161. https://doi.org/10.1161/01.str.21.8.1156CrossRefPubMed

22.

Huckman MS, Fox J, Topel J (1975) The validity of criteria for the evaluation of cerebral atrophy by computed tomography. Radiology 116:85–92. https://doi.org/10.1148/116.1.85CrossRefPubMed

23.

Hughes JD, Puffer R, Rabinstein AA (2015) Risk factors for hydrocephalus requiring external ventricular drainage in patients with intraventricular hemorrhage. J Neurosurg 123:1439–1446. https://doi.org/10.3171/2015.1.JNS142391CrossRefPubMed

24.

Hunt WE, Hess RM (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14–20. https://doi.org/10.3171/jns.1968.28.1.0014CrossRefPubMed

25.

Hussein K, Rabino G, Feder O et al (2019) Risk factors for meningitis in neurosurgical patients with cerebrospinal fluid drains: prospective observational cohort study. Acta Neurochir (Wien) 161:517–524. https://doi.org/10.1007/s00701-019-03801-yCrossRefPubMed

26.

Jabbarli R, Reinhard M, Niesen WD et al (2015) Predictors and impact of early cerebral infarction after aneurysmal subarachnoid hemorrhage. Eur J Neurol 22:941–947. https://doi.org/10.1111/ene.12686CrossRefPubMed

27.

Jabbarli R, Bohrer AM, Pierscianek D et al (2016) The CHESS score: a simple tool for early prediction of shunt dependency after aneurysmal subarachnoid hemorrhage. Eur J Neurol 23:912–918. https://doi.org/10.1111/ene.12962CrossRefPubMed

28.

Jabbarli R, Pierscianek D, Ro R et al (2018) Gradual external ventricular drainage weaning reduces the risk of shunt dependency after aneurysmal subarachnoid hemorrhage: a pooled analysis. Oper Neurosurg (Hagerstown) 15:498–504. https://doi.org/10.1093/ons/opy009CrossRefPubMed

29.

Jabbarli R, Darkwah Oppong M, Roelz R et al (2020) The PRESSURE score to predict decompressive craniectomy after aneurysmal subarachnoid haemorrhage. Brain Commun 2:fcaa134. https://doi.org/10.1093/braincomms/fcaa134CrossRefPubMedPubMedCentral

30.

Kanat A, Turkmenoglu O, Aydin MD et al (2013) Toward changing of the pathophysiologic basis of acute hydrocephalus after subarachnoid hemorrhage: a preliminary experimental study. World Neurosurg 80:390–395. https://doi.org/10.1016/j.wneu.2012.12.020CrossRefPubMed

31.

Karypidou E, Megagiannis P, Papaoikonomou D et al (2019) Callosal angle and Evans index predict beta amyloid and tau protein in patients with dementia. Hell J Nucl Med 22:51–58PubMed

32.

LeMay M (1984) Radiologic changes of the aging brain and skull. AJR Am J Roentgenol 143:383–389. https://doi.org/10.2214/ajr.143.2.383CrossRefPubMed

33.

Li H, Pan R, Wang H et al (2013) Clipping versus coiling for ruptured intracranial aneurysms: a systematic review and meta-analysis. Stroke 44:29–37. https://doi.org/10.1161/STROKEAHA.112.663559CrossRefPubMed

34.

Luque-Paz D, Revest M, Eugene F et al (2021) Ventriculitis: a severe complication of central nervous system infections. Open Forum Infect Dis 8:ofab216. https://doi.org/10.1093/ofid/ofab216CrossRefPubMedPubMedCentral

35.

Milan JB, Jensen TSR, Norager N et al (2023) The ASPECT Hydrocephalus System: a non-hierarchical descriptive system for clinical use. Acta Neurochir (Wien) 165:355–365. https://doi.org/10.1007/s00701-022-05412-6CrossRefPubMed

36.

Morgan TC, Dawson J, Spengler D et al (2013) The Modified Graeb Score: an enhanced tool for intraventricular hemorrhage measurement and prediction of functional outcome. Stroke 44:635–641. https://doi.org/10.1161/STROKEAHA.112.670653CrossRefPubMedPubMedCentral

37.

Nakajima M, Yamada S, Miyajima M et al (2021) Guidelines for management of idiopathic normal pressure hydrocephalus (third edition): endorsed by the Japanese Society of Normal Pressure Hydrocephalus. Neurol Med Chir (Tokyo) 61:63–97. https://doi.org/10.2176/nmc.st.2020-0292CrossRefPubMed

38.

Oguro H, Okada K, Yamaguchi S et al (1998) Sex differences in morphology of the brain stem and cerebellum with normal ageing. Neuroradiology 40:788–792. https://doi.org/10.1007/s002340050685CrossRefPubMed

39.

Pelicci LJ, Bedrick AD, Cruse RP et al (1979) Frontal ventricular dimensions of the brain in infants and children. Arch Neurol 36:852–853. https://doi.org/10.1001/archneur.1979.00500490066011CrossRefPubMed

40.

Rincon F, Gordon E, Starke RM et al (2010) Predictors of long-term shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage. Clinical article. J Neurosurg 113:774–780. https://doi.org/10.3171/2010.2.JNS09376CrossRefPubMed

41.

Rubinos C, Kwon SB, Megjhani M et al (2022) Predicting shunt dependency from the effect of cerebrospinal fluid drainage on ventricular size. Neurocrit Care. https://doi.org/10.1007/s12028-022-01538-8

42.

Said M, Dinger TF, Gumus M et al (2022) Impact of anemia severity on the outcome of an aneurysmal subarachnoid hemorrhage. J Clin Med 11. https://doi.org/10.3390/jcm11216258

43.

Said M, Gumus M, Herten A et al (2021) Subarachnoid hemorrhage early brain edema score (SEBES) as a radiographic marker of clinically relevant intracranial hypertension and unfavorable outcome after subarachnoid hemorrhage. Eur J Neurol 28:4051–4059. https://doi.org/10.1111/ene.15033CrossRefPubMed

44.

Scheithauer S, Burgel U, Ryang YM et al (2009) Prospective surveillance of drain associated meningitis/ventriculitis in a neurosurgery and neurological intensive care unit. J Neurol Neurosurg Psychiatry 80:1381–1385. https://doi.org/10.1136/jnnp.2008.165357CrossRefPubMed

45.

Shigematsu H, Sorimachi T, Osada T et al (2016) Predictors of early vs. late permanent shunt insertion after aneurysmal subarachnoid hemorrhage. Neurol Res 38:600–605. https://doi.org/10.1080/01616412.2016.1199184CrossRefPubMed

46.

Steed TC, Treiber JM, Brandel MG et al (2018) Quantification of glioblastoma mass effect by lateral ventricle displacement. Sci Rep 8:2827. https://doi.org/10.1038/s41598-018-21147-wCrossRefPubMedPubMedCentral

47.

Stratchko L, Filatova I, Agarwal A et al (2016) The ventricular system of the brain: anatomy and normal variations. Semin Ultrasound CT MR 37:72–83. https://doi.org/10.1053/j.sult.2016.01.004CrossRefPubMed

48.

Synek V, Reuben JR, Du Boulay GH (1976) Comparing Evans' index and computerized axial tomography in assessing relationship of ventricular size to brain size. Neurology 26:231–233. https://doi.org/10.1212/wnl.26.3.231CrossRefPubMed

49.

Tan Q, Chen Q, Feng Z et al (2017) Cannabinoid receptor 2 activation restricts fibrosis and alleviates hydrocephalus after intraventricular hemorrhage. Brain Res 1654:24–33. https://doi.org/10.1016/j.brainres.2016.10.016CrossRefPubMed

50.

Varelas P, Helms A, Sinson G et al (2006) Clipping or coiling of ruptured cerebral aneurysms and shunt-dependent hydrocephalus. Neurocrit Care 4:223–228. https://doi.org/10.1385/NCC:4:3:223CrossRefPubMed

51.

Weigl C, Bruendl E, Schoedel P et al (2020) III. Ventricle diameter increase during ventricular drainage challenge - a predictor of shunt dependency after subarachnoid hemorrhage. J Clin Neurosci 72:198–201. https://doi.org/10.1016/j.jocn.2019.12.011CrossRefPubMed

52.

Wilson DA, Nakaji P, Abla AA et al (2012) A simple and quantitative method to predict symptomatic vasospasm after subarachnoid hemorrhage based on computed tomography: beyond the Fisher scale. Neurosurgery 71:869–875. https://doi.org/10.1227/NEU.0b013e318267360fCrossRefPubMed

53.

Wilson CD, Safavi-Abbasi S, Sun H et al (2017) Meta-analysis and systematic review of risk factors for shunt dependency after aneurysmal subarachnoid hemorrhage. J Neurosurg 126:586–595. https://doi.org/10.3171/2015.11.JNS152094CrossRefPubMed

54.

Yamada S, Ishikawa M, Yamamoto K et al (2015) Aneurysm location and clipping versus coiling for development of secondary normal-pressure hydrocephalus after aneurysmal subarachnoid hemorrhage: Japanese Stroke DataBank. J Neurosurg 123:1555–1561. https://doi.org/10.3171/2015.1.JNS142761CrossRefPubMed

55.

Yang TC, Chang CH, Liu YT et al (2013) Predictors of shunt-dependent chronic hydrocephalus after aneurysmal subarachnoid haemorrhage. Eur Neurol 69:296–303. https://doi.org/10.1159/000346119CrossRefPubMed

56.

Yee SV, Ghani AR, Raffiq A (2020) Review of CHESS score in SAH patients in local malaysian population. J Neurosci Rural Pract 11:113–118. https://doi.org/10.1055/s-0039-3402573CrossRefPubMedPubMedCentral

57.

Yu H, Zhan R, Wen L et al (2014) The relationship between risk factors and prognostic factors in patients with shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage. J Craniofac Surg 25:902–906. https://doi.org/10.1097/SCS.0000000000000561CrossRefPubMed

Title: The value of ventricular measurements in the prediction of shunt dependency after aneurysmal subarachnoid hemorrhage
Authors: Maryam Said
Meltem Gümüs
Jan Rodemerk
Mehdi Chihi
Laurèl Rauschenbach
Thiemo F. Dinger
Marvin Darkwah Oppong
Philipp Dammann
Karsten H. Wrede
Ulrich Sure
Ramazan Jabbarli
Publication date: 02-05-2023
Publisher: Springer Vienna
Keywords: Addiction
Subarachnoid Hemorrhage
Hydrocephalus
Hydrocephalus
Subarachnoid Hemorrhage
Hydrocephalus
Addiction
Published in: Acta Neurochirurgica / Issue 6/2023
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-023-05595-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The value of ventricular measurements in the prediction of shunt dependency after aneurysmal subarachnoid hemorrhage

Abstract

Objective

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2023

Free-water correction DTI-based tractography in brain tumor surgery: assessment with functional and electrophysiological mapping of the white matter

Biportal endoscopic extraforaminal lumbar interbody fusion using a 3D-printed porous titanium cage with large footprints: technical note and preliminary results

Safety and technical efficacy of early minimally invasive endoscopy-guided surgery for intracerebral haemorrhage: the Dutch Intracerebral haemorrhage Surgery Trial pilot study

Postoperative delirium after intracranial neurosurgery: A prospective cohort study from a developing nation

Intraoperative DSA-guided minimal approach for craniocervical junction DAVFs obliteration

The benefits of automated CSF drainage in normal pressure hydrocephalus