Risk factors analysis of shunt-dependent hydrocephalus in patients with aneurysmal subarachnoid hemorrhage after operation

Objective：To analyze the incidence and risk factors of shunt-dependent hydrocephalus (SDHC) in patients with aneurysmal subarachnoid hemorrhage after operation. Methods：The data of 108 patients who underwent endovascular intervention treatment or surgical clipping for ruptured aneurysms were retrospective analysis. The demographic and clinical characteristics of patients in No-SDHC and SDHC groups were compared. Uni- and multivariate logistic regression analysis were performed to evaluate the risk factors for the occurrence of postoperative SDHC. Results：Among the 108 patients, female was dominant (63.0%) with mean age of (59.6±8.9) years. During a median follow-up period of 63.0 months, SDHC developed in 33 patients (30.6%). Compared with No-SDHC group, the patients in SDHC group had higher Hunt-Hess grade 4-5, Fisher grade 3-4, acute hydrocephalus, and surgical clipping rates (P<0.01). Univariate logistic regression analysis showed that Hunt-Hess grade 4-5, Fisher grade 3-4 , middle cerebral aneurysm, acute hydrocephalus, surgical clipping, and without cerebrospinal fluid drainage were risk factors for SDHC (P<0.05). Multivariate logistic regression analysis showed that Fisher grade 3-4 (OR=6.406, 95% CI 1.800-22.799, P=0.004) and without cerebrospinal fluid drainage (OR=14.267, 95% CI 1.196-170.268, P=0.036) were predictive factors for SDHC. Conclusions：The patients with high Fisher grade (3-4) and without cerebrospinal fluid drainage may prone to SDHC, which should be paid attention to.