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  • A Proposed Grading System for Assessment of Post-Surgical Hydrocephalus Risk in Microsurgically Treated Aneurysm Patients

    Final Number:

    Peyton Lubbock Nisson BS; Ali Tayebi Meybodi MD; Whitney S. James; Arnau Benet-Cabero M.D.; Garrett Kenneth Berger BS; Michael T. Lawton MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: A debilitating complication following microsurgical treatment of aneurysms is the development of post-surgical hydrocephalus. It is often difficult to predict which patients will suffer this post-operative complication. In this study, we identified risk factors for the development of postsurgical hydrocephalus and propose a grading system for identifying patients at high risk.

    Methods: Solitary aneurysms microsurgically treated by the senior author (M.T.L.) were included from a database of patients treated between January 2010-April 2013 at a tertiary academic medical center. Follow-up on patients was performed up to 1 year after surgery.

    Results: A total 353 patients were included in the study. Post-surgical hydrocephalus occurred in 7.1% (25/353) of patients; 17 (68%) of whom were identified before discharge, 5 (20%) at one-month follow-up, 1 (4%) at 6 months, and 2 (8%) at 1-year. Mean follow-up time was 2.5 months. Hydrocephalus occurred in a significantly greater proportion of patients who presented with a blood WBC =15,000 at presentation (41.7% vs. 11.8%, p-value=<.001), presented in poor neurologic status (64% vs. 18.9%, p-value=<.001), experienced post-operative vasospasm (60% vs. 25.7%, p-value=<.001), and had a HH score =2 (80% vs. 40.4%, p-value=.001); hypertension trended towards significance (76% vs. 55.9%, p-value=.05). We devised a risk-point based grading system; Poor neurologic status at presentation (+3 Points), HH =2 (+3 Points), blood WBC=15,000 (+2 Points), vasospasm (+1 Point), and hypertension (+1). In the Low-Risk Grade group (Points <8), 3.9% (12/307) developed hydrocephalus, while in the High-Risk Grade (=8 Points) 28.3% (13/46) did (p-value=<.001). Using logistic regression, the High-Risk group was 9.68x more likely to suffer from hydrocephalus (p-value=<.001, AUROC=.71).

    Conclusions: Our purposed grading system indicates almost 1 in 3 patients categorized as ‘High Risk’ will experience this post-operative complication up to 1-year after treatment. Future, prospective data is needed to validate the reliability of this grading system.

    Patient Care: This research may help in identifying patients high risk for developing post-surgical hydrocephalus, allowing them to be more readily identified and potentially intervened at an earlier time point, preventing against complications and permanent neurologic damage associated with untreated hydrocephalus.

    Learning Objectives: By the conclusion of this session, participants should be able to 1) identify risk factors associated with post-surgical hydrocephalus in patients treated with microsurgical clipping and 2) to be able to more quickly identify patients at risk for developing this complication.


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