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document
Long-term functional outcomes and predictors of shunt-dependent hydrocephalus after treatment of ruptured intracranial aneurysms in the BRAT trial : revisiting the clip vs coil debate . BACKGROUND Acute hydrocephalus is a well-known sequela of aneurysmal subarachnoid hemorrhage ( SAH ) . Controversy exists about whether open microsurgical methods serve to reduce shunt dependency compared with endovascular techniques . OBJECTIVE To determine predictors of shunt-dependent hydrocephalus and functional outcomes after aneurysmal SAH . METHODS A total of 471 patients who were part of a prospective , randomized , controlled trial from 2003 to 2007 were retrospectively reviewed . All variables including demographic data , medical history , treatment , imaging , and functional outcomes were included as part of the trial . No additional variables were retrospectively collected . RESULTS Ultimately , 147 patients ( 31.2 % ) required a ventriculoperitoneal shunt ( VPS ) in our series . Age , dissecting aneurysm type , ruptured vertebrobasilar aneurysm , Fisher grade , Hunt and Hess grade , admission intraventricular hemorrhage , admission intraparenchymal hemorrhage , blood in the fourth ventricle on admission , perioperative ventriculostomy , and hemicraniectomy were significant risk factors ( P < .05 ) associated with shunt-dependent hydrocephalus on univariate analysis . On multivariate analysis , intraventricular hemorrhage and intraparenchymal hemorrhage were independent risk factors for shunt dependency ( P < .05 ) . Clipping vs coiling treatment was not statistically associated with VPS after SAH on both univariate and multivariate analyses . Patients who did not receive a VPS at discharge had higher Glasgow Outcome Scale and Barthel Index scores and were more likely to be functionally independent and to return to work 72 months after surgery ( P < .05 ) . CONCLUSION There is no difference in shunt dependency after SAH among patients treated by endovascular or microsurgical means . Patients in whom shunt-dependent hydrocephalus does not develop after SAH tend to have improved long-term functional outcomes .
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Intervention_Surgical
Clipping
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Intervention_Surgical
coiling
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Outcome_Physical
shunt-dependent hydrocephalus
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Outcome_Physical
shunt dependency
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Outcome_Physical
shunt-dependent hydrocephalus
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Outcome_Mental
functional outcomes
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Outcome_Mental
functional outcomes
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Outcome_Physical
shunt-dependent hydrocephalus
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Outcome_Physical
intraventricular hemorrhage
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Outcome_Physical
intraparenchymal hemorrhage
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Outcome_Physical
shunt dependency
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Outcome_Physical
Glasgow Outcome Scale
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Outcome_Physical
Barthel Index
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Outcome_Physical
shunt dependency
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Outcome_Physical
shunt-dependent hydrocephalus
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Participant_Condition
after treatment of ruptured intracranial aneurysms
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Participant_Condition
Acute hydrocephalus
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Participant_Sample-size
471 patients
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Participant_Condition
part of a prospective , randomized , controlled trial from 2003 to 2007 were retrospectively reviewed
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Participant_Condition
patients treated by endovascular or microsurgical means
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Participant_Condition
shunt-dependent hydrocephalus