Xie et al performed a meta-analysis of studies on shunt dependency after aneurysmal subarachnoid hemorrhage. These can help to identify a patient who may benefit from more aggressive management. The authors are from Sichuan University in China.

Patient selection: aneurysmal subarachnoid hemorrhage


Outcome: shunt-dependent hydrocephalus


Predictors of shunt dependency:

(1) age >= 50 years

(2) female sex

(3) Hunt & Hess grade (some use >= III, some use >= IV)

(4) Glasgow coma scale <= 8

(5) Fisher Grade >= 3 (out of 4)

(6) acute hydrocephalus

(7) insertion of an external ventricular drain

(8) intraventricular hemorrhage

(9) aneurysm in the posterior circulation

(10) aneurysm in the anterior communicating artery

(11) meningitis

(12) rebleeding


The risk for shunt-dependency should increase as the number of predictors increase.

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