Introduction: There is a lack of data regarding risk factors for treatment failure following VP shunt implantation in patients with posthaemorrhagic hydrocephalus after aneurysmatic subarachnoid haemorrhage. The clinical outcome of patients with shunt-dependent, posthaemorrhagic hydrocephalus (pHC) was analysed in relation to the implanted valve type. The influence of the change in ventricular width after external ventricular drain and shunt placement on shunt failure, respectively, was analysed.
Methods: 547 patients with aneurysmatic SAH were treated at our institution, 114 of which underwent shunt placement (21.1%). 47 Patients were included. Valve types were categorized into different subgroups. Ventricular width was analysed before and after surgical intervention. Initial equalized shunt survival (IESS) was analysed, including surgical revisions for the treatment of over- or under-drainage, as well as re-programming of adjustable valve.
Results: Different kinds of shunt valves were used. Twenty patients were treated with differential pressure valves (15 patients with flow regulated valves, 12 with differential pressure valves assisted by a gravitational unit). The flow-regulated valve group showed longer IESS as a trend. Patients who reacted with substantial changes in the ventricular width after insertion of an external ventricular drainage showed longer IESS. Patients who reacted with smaller changes in ventricular width after VP shunt placement showed longer IESS.
Conclusions: Aneurysm-associated pHC might be a heterogeneous entity. Reduction in ventricular width after EVD placement was a predictor of successful VP shunt therapy. This could allow the identification of patients who need specific valve types or valve settings and a higher follow-up frequency.
Patient Care: The analysis of ventricular width after insertion of EVD might predict failure of treatment of VP shunting of these patients at a later stage and is therefore worth being analysed.
Learning Objectives: Change of ventricular width after initial insertion of EVD in SAH related hydrocephalus is an interesting parameter hinting at the potential underlying hydrocephalus etiology