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Link to original content: http://pubmed.ncbi.nlm.nih.gov/35765929/
Prediction of Shunt-Dependent Hydrocephalus after Primary Supratentorial Intracerebral Hemorrhage with a Focus on the Influence of Craniectomies - PubMed Skip to main page content
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. 2022 Jul;65(4):582-590.
doi: 10.3340/jkns.2021.0142. Epub 2022 Jun 30.

Prediction of Shunt-Dependent Hydrocephalus after Primary Supratentorial Intracerebral Hemorrhage with a Focus on the Influence of Craniectomies

Yong-Sook Park  1 , Joon Cho  2
Affiliations

Prediction of Shunt-Dependent Hydrocephalus after Primary Supratentorial Intracerebral Hemorrhage with a Focus on the Influence of Craniectomies

Yong-Sook Park et al. J Korean Neurosurg Soc. 2022 Jul.

Abstract

Objective: Hydrocephalus after intracerebral hemorrhage (ICH) is known to be related to poor prognosis and mortality. We analyzed predictors of permanent hydrocephalus in the patients with surgically treated supratentorial ICH.

Methods: From 2004 to 2019, a total of 414 patients with surgically treated primary supratentorial ICH were included. We retrospectively analyzed age, sex, preexisting hypertension and diabetes, location and volume of ICH, presence and severity of intraventricular hemorrhage (IVH), and type of surgery.

Results: Forty patients (9.7%) required shunt surgery. Concomitant IVH was higher in the 'shunt required' group (92.5%) than in the 'shunt not required' group (67.9%) (p=0.001). IVH severity was worse in the 'shunt required' group (13.5 vs. 7.5, p=0.008). Craniectomy (47.5%) was significantly high in the 'shunt required' group. According to multivariable analysis, the presence of an IVH was 8.1 times more frequent and craniectomy was 8.6 times more frequent in the 'shunt required' group. In the comparison between craniotomy and craniectomy group, the presence of an IVH was related with a 3.9 times higher (p=0.033) possibility and craniectomies rather than craniotomies with a 7-times higher possibility of shunt surgery (p<0.001). Within the craniectomy group, an increase in the craniectomy area by 1 cm2 was correlated with a 3.2% increase in the possibility of shunt surgery (odds ratio, 1.032; 95% confidence interval, 1.005-1.061; p=0.022).

Conclusion: Presence of IVH, the severity of IVH and decompressive craniectomy were related to the development of shunt dependent hydrocephalus in the patients with ICH. The increasing size of craniectomy was related with increasing rate of shunt requirement.

Keywords: Cerebral hemorrhage; Cerebrospinal fluid shunts; Decompressive craniectomy; Hydrocephalus.

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Conflict of interest statement

Conflicts of interest

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Illustrative cases of shunt-dependent hydrocephalus in patients with intracerebral hemorrhage (ICH). A : A 50-year-old male presented with right putaminal hemorrhage (left column). After a craniectomy, the ICH was removed completely (middle column), and hydrocephalus developed at 2 months after ICH (right column). B : A 54-year-old male presented with right posterior putaminal hemorrhage (left column). After a craniotomy, the ICH was removed completely (middle column), and he was without signs of hydrocephalus at 2 months after ICH (right column). C : A 70-year-old female presented with a right frontal cortical hematoma (left column). After a craniectomy, the ICH was removed completely (middle column), and hydrocephalus developed at 2 weeks after surgery (right column). D : A 74-year-old female presented with right occipital cortical hemorrhage with ventricular extension (left column). With a craniotomy, the ICH and IVH were removed (middle column), and she was without any sign of hydrocephalus at 2 months after ICH (right column).
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