Predictors of Shunt Insertion in Aneurysmal Subarachnoid Hemorrhage

Rouzbeh Motiei-Langroudi, Nimer Adeeb, Paul M. Foreman, Mark R. Harrigan, Winfield S. Fisher, Nilesh A. Vyas, Robert H. Lipsky, Beverly C. Walters, Shane R. Tubbs, Mohammadali Mohajel Shoja, Justin M. Moore, Raghav Gupta, Christopher S. Ogilvy, Ajith J. Thomas, Christoph J. Griessenauer

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective Hydrocephalus is a common complication of aneurysmal subarachnoid hemorrhage (aSAH), requiring permanent cerebrospinal fluid (CSF) diversion in up to two thirds of patients. Factors that predict permanent CSF diversion are not well established. Methods An exploratory analysis of 149 patients enrolled in the CARAS (Cerebral Aneurysm Renin Angiotensin System) study was performed in an effort to identify factors predictive of permanent CSF diversion after aSAH; only the 135 patients surviving the initial hospitalization were included in the present study. CARAS was a prospective, multicenter study investigating the impact of genetic polymorphisms in patients with aSAH and enrolled patients from September 2012 to January 2015. Results One hundred and forty-nine patients with aSAH were enrolled in CARAS, with 135 (90.6%) patients surviving the initial hospitalization. Sixty-four of these patients (47.4%) required permanent CSF diversion. Multivariable analysis identified the following as independent risk factors: sympathomimetic illicit drug use, external ventricular drain (EVD) insertion, and hyponatremia. A scoring system based on EVD insertion (2 points), Hunt and Hess grade (1 point if grade ≥4) and modified Fisher computed tomography grade (1 point if grade 4) produced an area under the curve of 0.8 (P < 0.001). Conclusions Sympathomimetic illicit drug use, EVD insertion, and hyponatremia are the strongest predictors of shunt insertion in patients with aSAH. Moreover, a scoring system based on EVD insertion, Hunt and Hess grade, and modified Fisher computed tomography grade can reliably predict the need for shunt placement in patients with aSAH.

Original languageEnglish (US)
Pages (from-to)421-426
Number of pages6
JournalWorld Neurosurgery
Volume98
DOIs
StatePublished - Feb 1 2017
Externally publishedYes

Fingerprint

Subarachnoid Hemorrhage
Cerebrospinal Fluid
Intracranial Aneurysm
Renin-Angiotensin System
Sympathomimetics
Hyponatremia
Street Drugs
Hospitalization
Tomography
Genetic Polymorphisms
Hydrocephalus
Multicenter Studies
Area Under Curve
Prospective Studies

Keywords

  • Aneurysm
  • Hydrocephalus
  • Predictor
  • Scoring system
  • Shunt
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Motiei-Langroudi, R., Adeeb, N., Foreman, P. M., Harrigan, M. R., Fisher, W. S., Vyas, N. A., ... Griessenauer, C. J. (2017). Predictors of Shunt Insertion in Aneurysmal Subarachnoid Hemorrhage. World Neurosurgery, 98, 421-426. https://doi.org/10.1016/j.wneu.2016.11.092

Predictors of Shunt Insertion in Aneurysmal Subarachnoid Hemorrhage. / Motiei-Langroudi, Rouzbeh; Adeeb, Nimer; Foreman, Paul M.; Harrigan, Mark R.; Fisher, Winfield S.; Vyas, Nilesh A.; Lipsky, Robert H.; Walters, Beverly C.; Tubbs, Shane R.; Mohajel Shoja, Mohammadali; Moore, Justin M.; Gupta, Raghav; Ogilvy, Christopher S.; Thomas, Ajith J.; Griessenauer, Christoph J.

In: World Neurosurgery, Vol. 98, 01.02.2017, p. 421-426.

Research output: Contribution to journalArticle

Motiei-Langroudi, R, Adeeb, N, Foreman, PM, Harrigan, MR, Fisher, WS, Vyas, NA, Lipsky, RH, Walters, BC, Tubbs, SR, Mohajel Shoja, M, Moore, JM, Gupta, R, Ogilvy, CS, Thomas, AJ & Griessenauer, CJ 2017, 'Predictors of Shunt Insertion in Aneurysmal Subarachnoid Hemorrhage', World Neurosurgery, vol. 98, pp. 421-426. https://doi.org/10.1016/j.wneu.2016.11.092
Motiei-Langroudi R, Adeeb N, Foreman PM, Harrigan MR, Fisher WS, Vyas NA et al. Predictors of Shunt Insertion in Aneurysmal Subarachnoid Hemorrhage. World Neurosurgery. 2017 Feb 1;98:421-426. https://doi.org/10.1016/j.wneu.2016.11.092
Motiei-Langroudi, Rouzbeh ; Adeeb, Nimer ; Foreman, Paul M. ; Harrigan, Mark R. ; Fisher, Winfield S. ; Vyas, Nilesh A. ; Lipsky, Robert H. ; Walters, Beverly C. ; Tubbs, Shane R. ; Mohajel Shoja, Mohammadali ; Moore, Justin M. ; Gupta, Raghav ; Ogilvy, Christopher S. ; Thomas, Ajith J. ; Griessenauer, Christoph J. / Predictors of Shunt Insertion in Aneurysmal Subarachnoid Hemorrhage. In: World Neurosurgery. 2017 ; Vol. 98. pp. 421-426.
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abstract = "Objective Hydrocephalus is a common complication of aneurysmal subarachnoid hemorrhage (aSAH), requiring permanent cerebrospinal fluid (CSF) diversion in up to two thirds of patients. Factors that predict permanent CSF diversion are not well established. Methods An exploratory analysis of 149 patients enrolled in the CARAS (Cerebral Aneurysm Renin Angiotensin System) study was performed in an effort to identify factors predictive of permanent CSF diversion after aSAH; only the 135 patients surviving the initial hospitalization were included in the present study. CARAS was a prospective, multicenter study investigating the impact of genetic polymorphisms in patients with aSAH and enrolled patients from September 2012 to January 2015. Results One hundred and forty-nine patients with aSAH were enrolled in CARAS, with 135 (90.6{\%}) patients surviving the initial hospitalization. Sixty-four of these patients (47.4{\%}) required permanent CSF diversion. Multivariable analysis identified the following as independent risk factors: sympathomimetic illicit drug use, external ventricular drain (EVD) insertion, and hyponatremia. A scoring system based on EVD insertion (2 points), Hunt and Hess grade (1 point if grade ≥4) and modified Fisher computed tomography grade (1 point if grade 4) produced an area under the curve of 0.8 (P < 0.001). Conclusions Sympathomimetic illicit drug use, EVD insertion, and hyponatremia are the strongest predictors of shunt insertion in patients with aSAH. Moreover, a scoring system based on EVD insertion, Hunt and Hess grade, and modified Fisher computed tomography grade can reliably predict the need for shunt placement in patients with aSAH.",
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AU - Fisher, Winfield S.

AU - Vyas, Nilesh A.

AU - Lipsky, Robert H.

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AU - Mohajel Shoja, Mohammadali

AU - Moore, Justin M.

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N2 - Objective Hydrocephalus is a common complication of aneurysmal subarachnoid hemorrhage (aSAH), requiring permanent cerebrospinal fluid (CSF) diversion in up to two thirds of patients. Factors that predict permanent CSF diversion are not well established. Methods An exploratory analysis of 149 patients enrolled in the CARAS (Cerebral Aneurysm Renin Angiotensin System) study was performed in an effort to identify factors predictive of permanent CSF diversion after aSAH; only the 135 patients surviving the initial hospitalization were included in the present study. CARAS was a prospective, multicenter study investigating the impact of genetic polymorphisms in patients with aSAH and enrolled patients from September 2012 to January 2015. Results One hundred and forty-nine patients with aSAH were enrolled in CARAS, with 135 (90.6%) patients surviving the initial hospitalization. Sixty-four of these patients (47.4%) required permanent CSF diversion. Multivariable analysis identified the following as independent risk factors: sympathomimetic illicit drug use, external ventricular drain (EVD) insertion, and hyponatremia. A scoring system based on EVD insertion (2 points), Hunt and Hess grade (1 point if grade ≥4) and modified Fisher computed tomography grade (1 point if grade 4) produced an area under the curve of 0.8 (P < 0.001). Conclusions Sympathomimetic illicit drug use, EVD insertion, and hyponatremia are the strongest predictors of shunt insertion in patients with aSAH. Moreover, a scoring system based on EVD insertion, Hunt and Hess grade, and modified Fisher computed tomography grade can reliably predict the need for shunt placement in patients with aSAH.

AB - Objective Hydrocephalus is a common complication of aneurysmal subarachnoid hemorrhage (aSAH), requiring permanent cerebrospinal fluid (CSF) diversion in up to two thirds of patients. Factors that predict permanent CSF diversion are not well established. Methods An exploratory analysis of 149 patients enrolled in the CARAS (Cerebral Aneurysm Renin Angiotensin System) study was performed in an effort to identify factors predictive of permanent CSF diversion after aSAH; only the 135 patients surviving the initial hospitalization were included in the present study. CARAS was a prospective, multicenter study investigating the impact of genetic polymorphisms in patients with aSAH and enrolled patients from September 2012 to January 2015. Results One hundred and forty-nine patients with aSAH were enrolled in CARAS, with 135 (90.6%) patients surviving the initial hospitalization. Sixty-four of these patients (47.4%) required permanent CSF diversion. Multivariable analysis identified the following as independent risk factors: sympathomimetic illicit drug use, external ventricular drain (EVD) insertion, and hyponatremia. A scoring system based on EVD insertion (2 points), Hunt and Hess grade (1 point if grade ≥4) and modified Fisher computed tomography grade (1 point if grade 4) produced an area under the curve of 0.8 (P < 0.001). Conclusions Sympathomimetic illicit drug use, EVD insertion, and hyponatremia are the strongest predictors of shunt insertion in patients with aSAH. Moreover, a scoring system based on EVD insertion, Hunt and Hess grade, and modified Fisher computed tomography grade can reliably predict the need for shunt placement in patients with aSAH.

KW - Aneurysm

KW - Hydrocephalus

KW - Predictor

KW - Scoring system

KW - Shunt

KW - Subarachnoid hemorrhage

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