J Korean Neurosurg Soc.  2012 Nov;52(5):441-446. 10.3340/jkns.2012.52.5.441.

Effect of Cisternal Drainage on the Shunt Dependency Following Aneurysmal Subarachnoid Hemorrhage

• Kim SH
• Chung PW
• Won YS
• Kwon YJ
• Shin HC
• Choi CS

• KMID: 2018249
• DOI: http://doi.org/10.3340/jkns.2012.52.5.441

Abstract

OBJECTIVE
Shunt-dependent chronic hydrocephalus (SDCH) is known to be a major complication associated with aneurysmal subarachnoid hemorrhage (aSAH). Old age is known to be one of numerous factors related to the development of SDCH. This study investigated whether postoperative cisternal drainage affects the incidence of SDCH and clinical outcome in elderly patients with aSAH.
METHODS
Fifty-nine patients participated in this study. All patients underwent aneurysmal clipping with cisternal cerebrospinal fluid (CSF) drainage. Clinical variables relevant to the study included age, sex, location of ruptured aneurysm, CT finding and clinical state on admission, clinical outcome, and CSF drainage. We first divided patients into two groups according to age (<70 years of age and > or =70 years of age) and compared the two groups. Secondly, we analyzed variables to find factors associated with SDCH in both groups (<70 years of age and > or =70 years of age).
RESULTS
Of 59 patients, SDCH was observed in 20 patients (33.9 %), who underwent shunt placement for treatment of hydrocephalus. Forty seven percent of cases of acute hydrocephalus developed SDCH. In the elderly group (> or =70 years of age), the duration and amount of CSF drainage did not affect the development of chronic hydrocephalus.
CONCLUSION
In elderly patients, although the incidence of SDCH was significantly higher, clinical outcome was acceptable. The duration and the amount of cisternal drainage did not seem to be related to subsequent development of chronic hydrocephalus within elderly patients aged 70 or older.

Keyword

Aneurysmal subarachnoid hemorrhage; Acute hydrocephalus; Shunt-dependent chronic hydrocephalus; Old age; Intraventricular hemorrhage

MeSH Terms

Aged
Aneurysm
Aneurysm, Ruptured
Dependency (Psychology)
Drainage
Humans
Hydrocephalus
Incidence
Subarachnoid Hemorrhage

Figure

• 

  Fig. 1 Brain computed tomography shows cisternal drainage tube placed in the chiasmatic cistern (A) or carotid cistern (B).

Reference

1. Auer LM, Mokry M. Disturbed cerebrospinal fluid circulation after subarachnoid hemorrhage and acute aneurysm surgery. Neurosurgery. 1990; 26:804–808. discussion 808-809. PMID: 2352599.

2. Black PM, Tzouras A, Foley L. Cerebrospinal fluid dynamics and hydrocephalus after experimental subarachnoid hemorrhage. Neurosurgery. 1985; 17:57–62. PMID: 4022288.

3. Dóczi T, Nemessányi Z, Szegváry Z, Huszka E. Disturbances of cerebrospinal fluid circulation during the acute stage of subarachnoid hemorrhage. Neurosurgery. 1983; 12:435–438. PMID: 6856069.

4. Dorai Z, Hynan LS, Kopitnik TA, Samson D. Factors related to hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery. 2003; 52:763–769. discussion 769-771. PMID: 12657171.

5. Fridriksson SM, Hillman J, Säveland H, Brandt L. Intracranial aneurysm surgery in the 8th and 9th decades of life: impact on population-based management outcome. Neurosurgery. 1995; 37:627–631. discussion 631-632. PMID: 8559289.

6. Gjerris F, Børgesen SE, Sørensen PS, Boesen F, Schmidt K, Harmsen A, et al. Resistance to cerebrospinal fluid outflow and intracranial pressure in patients with hydrocephalus after subarachnoid haemorrhage. Acta Neurochir (Wien). 1987; 88:79–86. PMID: 3687503.

7. Hasan D, Tanghe HL. Distribution of cisternal blood in patients with acute hydrocephalus after subarachnoid hemorrhage. Ann Neurol. 1992; 31:374–378. PMID: 1586137.

8. Hasan D, Vermeulen M, Wijdicks EF, Hijdra A, van Gijn J. Management problems in acute hydrocephalus after subarachnoid hemorrhage. Stroke. 1989; 20:747–753. PMID: 2728040.

9. Hirashima Y, Hamada H, Hayashi N, Kuwayama N, Origasa H, Endo S. Independent predictors of late hydrocephalus in patients with aneurysmal subarachnoid hemorrhage--analysis by multivariate logistic regression model. Cerebrovasc Dis. 2003; 16:205–210. PMID: 12865606.

10. Inagawa T. Cerebral vasospasm in elderly patients treated by early operation for ruptured intracranial aneurysms. Acta Neurochir (Wien). 1992; 115:79–85. PMID: 1605088.

11. Inagawa T. Cerebral vasospasm in elderly patients with ruptured intracranial aneurysms. Surg Neurol. 1991; 36:91–98. PMID: 1891761.

12. Inagawa T, Kamiya K, Matsuda Y. Effect of continuous cisternal drainage on cerebral vasospasm. Acta Neurochir (Wien). 1991; 112:28–36. PMID: 1763681.

13. Kasuya H, Shimizu T, Kagawa M. The effect of continuous drainage of cerebrospinal fluid in patients with subarachnoid hemorrhage : a retrospective analysis of 108 patients. Neurosurgery. 1991; 28:56–59. PMID: 1994282.

14. Kawakami Y, Shimamura Y. Cisternal drainage after early operation of ruptured intracranial aneurysm. Neurosurgery. 1987; 20:8–14. PMID: 3808282.

15. Klimo P Jr, Kestle JR, MacDonald JD, Schmidt RH. Marked reduction of cerebral vasospasm with lumbar drainage of cerebrospinal fluid after subarachnoid hemorrhage. J Neurosurg. 2004; 100:215–224. PMID: 15086227.

16. Kosteljanetz M. CSF dynamics in patients with subarachnoid and/or intraventricular hemorrhage. J Neurosurg. 1984; 60:940–946. PMID: 6716162.

17. Lanzino G, Kassell NF, Germanson TP, Kongable GL, Truskowski LL, Torner JC, et al. Age and outcome after aneurysmal subarachnoid hemorrhage : why do older patients fare worse? J Neurosurg. 1996; 85:410–418. PMID: 8751625.

18. Lee WC, Choi CH. The analysis of the need rate of shunt and outcome in hydrocephalus following SAH. J Korean Neurosurg Soc. 2001; 30:99–107.

19. Ljunggren B, Brandt L, Kågström E, Sundbärg G. Results of early operations for ruptured aneurysms. J Neurosurg. 1981; 54:473–479. PMID: 7205349.

20. Massicotte EM, Del Bigio MR. Human arachnoid villi response to subarachnoid hemorrhage : possible relationship to chronic hydrocephalus. J Neurosurg. 1999; 91:80–84. PMID: 10389884.

21. May C, Kaye JA, Atack JR, Schapiro MB, Friedland RP, Rapoport SI. Cerebrospinal fluid production is reduced in healthy aging. Neurology. 1990; 40:500–503. PMID: 2314595.

22. Mehta V, Holness RO, Connolly K, Walling S, Hall R. Acute hydrocephalus following aneurysmal subarachnoid hemorrhage. Can J Neurol Sci. 1996; 23:40–45. PMID: 8673961.

23. Milhorat TH. Acute hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery. 1987; 20:15–20. PMID: 3808257.

24. Ohwaki K, Yano E, Nakagomi T, Tamura A. Relationship between shunt-dependent hydrocephalus after subarachnoid haemorrhage and duration of cerebrospinal fluid drainage. Br J Neurosurg. 2004; 18:130–134. PMID: 15176553.

25. O'Kelly CJ, Kulkarni AV, Austin PC, Urbach D, Wallace MC. Shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage: incidence, predictors, and revision rates. Clinical article. J Neurosurg. 2009; 111:1029–1035. PMID: 19361256.

26. Pietilä TA, Heimberger KC, Palleske H, Brock M. Influence of aneurysm location on the development of chronic hydrocephalus following SAH. Acta Neurochir (Wien). 1995; 137:70–73. PMID: 8748872.

27. Reilly C, Amidei C, Tolentino J, Jahromi BS, Macdonald RL. Clot volume and clearance rate as independent predictors of vasospasm after aneurysmal subarachnoid hemorrhage. J Neurosurg. 2004; 101:255–261. PMID: 15309916.

28. Sajanti J, Heikkinen E, Majamaa K. Transient increase in procollagen propeptides in the CSF after subarachnoid hemorrhage. Neurology. 2000; 55:359–363. PMID: 10932268.

29. Schmieder K, Koch R, Lücke S, Harders A. Factors influencing shunt dependency after aneurysmal subarachnoid haemorrhage. Zentralbl Neurochir. 1999; 60:133–140. PMID: 10726336.

30. Sheehan JP, Polin RS, Sheehan JM, Baskaya MK, Kassell NF. Factors associated with hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery. 1999; 45:1120–1127. discussion 1127-1128. PMID: 10549928.

31. Suarez-Rivera O. Acute hydrocephalus after subarachnoid hemorrhage. Surg Neurol. 1998; 49:563–565. PMID: 9586937.

32. Tapaninaho A, Hernesniemi J, Vapalahti M, Niskanen M, Kari A, Luukkonen M, et al. Shunt-dependent hydrocephalus after subarachnoid haemorrhage and aneurysm surgery : timing of surgery is not a risk factor. Acta Neurochir (Wien). 1993; 123:118–124. PMID: 8237488.

33. Todo T, Usui M, Takakura K. Treatment of severe intraventricular hemorrhage by intraventricular infusion of urokinase. J Neurosurg. 1991; 74:81–86. PMID: 1984512.

34. Tomasello F, d'Avella D, de Divitiis O. Does lamina terminalis fenestration reduce the incidence of chronic hydrocephalus after subarachnoid hemorrhage? Neurosurgery. 1999; 45:827–831. discussion 831-832. PMID: 10515477.

35. Torvik A, Bhatia R, Murthy VS. Transitory block of the arachnoid granulations following subarachnoid haemorrhage. A postmortem study. Acta Neurochir (Wien). 1978; 41:137–146. PMID: 665326.

36. Vale FL, Bradley EL, Fisher WS 3rd. The relationship of subarachnoid hemorrhage and the need for postoperative shunting. J Neurosurg. 1997; 86:462–466. PMID: 9046303.

37. van Gijn J, Hijdra A, Wijdicks EF, Vermeulen M, van Crevel H. Acute hydrocephalus after aneurysmal subarachnoid hemorrhage. J Neurosurg. 1985; 63:355–362. PMID: 4020461.

38. Vermeij FH, Hasan D, Vermeulen M, Tanghe HL, van Gijn J. Predictive factors for deterioration from hydrocephalus after subarachnoid hemorrhage. Neurology. 1994; 44:1851–1855. PMID: 7936235.

39. Yong CI, Hwang SK, Kim SH. The role of lumbar drainage to prevent shunt-dependent hydrocephalus after coil embolization for aneurysmal subarachnoid hemorrhage in good-grade patients. J Korean Neurosurg Soc. 2010; 48:480–484. PMID: 21430972.

40. Yoshioka H, Inagawa T, Tokuda Y, Inokuchi F. Chronic hydrocephalus in elderly patients following subarachnoid hemorrhage. Surg Neurol. 2000; 53:119–124. discussion 124-125. PMID: 10713188.