Risk Factors for Ventriculoperitoneal Shunt Dependency in Patients with Spontaneous Cerebellar Hemorrhage

• Published in: World neurosurgery Vol. 105; pp. 63 - 68
• Main Authors: Hsu, Shih-Yuan, Chang, Hsin-Huan, Shih, Fu-Yuan, Lin, Yu-Jun, Lin, Wei-Che, Cheng, Ben-Chung, Su, Yu-Jih, Kung, Chia-Te, Ho, Yu-Ni, Tsai, Nai-Wen, Lu, Cheng-Hsien, Wang, Hung-Chen
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2017
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Female; Hematoma - surgery; Humans; Hydrocephalus; Hydrocephalus - etiology; Intracranial Hemorrhages - complications; Intracranial Hemorrhages - surgery; Middle Aged; Retrospective Studies; Risk factor; Risk Factors; Spontaneous cerebellar hemorrhage; Treatment Outcome; Ventriculoperitoneal shunt; Ventriculoperitoneal Shunt - methods; Hydrocephalus; Ventriculoperitoneal shunt; CH; CI; ROC; Spontaneous cerebellar hemorrhage; IQR; AUC; CT; GCS; Risk factor; CSF; VP
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.05.119

Hydrocephalus is a common complication after spontaneous cerebellar hemorrhage (CH). This study focused on predicting ventriculoperitorneal (VP) shunt dependency in patients with spontaneous CH. Ninety-nine patients with spontaneous CH were evaluated in this retrospective study. A comparison between patients with and those without VP shunt dependency during hospitalization was made. VP shunt–dependent hydrocephalus developed in 19.2% of the patients (19 of 99). Comparison of neuroimaging findings on admission between the 2 patient groups identified large hematoma dimension (P < 0.001), large hematoma volume (P = 0.001), fourth ventricular degradation (P < 0.001), development of hydrocephalus (P < 0.001), and obliteration of the basal cisterns (P < 0.001) as significant risk factors for VP shunt–dependent hydrocephalus. Stepwise logistic regression analysis identified hydrocephalus on admission and maximum hematoma diameter on admission as independent risk factors for VP shunt dependency (P = 0.006 and 0.020, respectively). The adjusted risk of VP shunt dependency for patients with hydrocephalus on admission had an odds ratio of 37.04. Furthermore, an increase of 1 mm in the blood clot diameter on admission would increase the VP shunt dependency rate by 11.9%. The cutoff value of blood clot diameter on presentation was 36.15 mm (sensitivity, 84.2%; specificity, 85.0%). A patient with hydrocephalus on admission and a hematoma of larger size and dimension at the time of initial imaging is at elevated risk for VP shunt dependency. Repeat neuroimaging studies and careful clinical assessment are mandatory for high-risk patients to determine the presence of post-CH hydrocephalus.