Characteristics of delayed intracerebral hemorrhage after ventriculoperitoneal shunt insertion.

Shiming Zhang,Zhengquan Yu,Li Xu,Jiang Wu,Peng Yang,Gang Chen,Zhong Wang,Weiyi Gong

doi:10.18632/oncotarget.17444

Abstract

BackgroundDelayed intracerebral hemorrhage after ventriculoperitoneal (VP) shunt insertion is rare and has not been well investigated previously. Its characteristics is still unknown.ObjectiveWe reported 12 patients with delayed intracerebral hemorrhage after VP shunt to investigate the potential risk factors and the outcome.Results12 patients (1.59%) of all the 754 hydrocephalus had delayed intracerebral hemorrhage after VP shunt insertion. 4 patients were women and 8 patients were men, ranging in age from 50 to 76 years. The delayed cerebral hemorrhage from day 3 to day 7 post operation was diagnosed by repeated CT. The delayed intracerebral hemorrhage was significantly related to age, prior craniotomy operation history and manipulation of valve system (3–7 days). Neither gender sexuality nor potential risk factors for postoperative hemorrhage (including anticoagulation/antiplatelet status, liver disease, diabetes, hypertension), time of shunt attempt affected the happen of delayed intracerebral hemorrhage.Materials and MethodsThe clinical characteristics including sex, age, anticoagulation/antiplatelet status, liver disease, diabetes, hypertension, craniotomy operation history, manipulation of valve system and time of shunt attempt of 754 patients who were surgically treated of VP shunt at the first affiliated hospital of Soochow University between 2007 and 2013 were reviewed retrospectively. The potential risk factors of the delayed intracerebral hemorrhage were statistically analyzed.ConclusionsThis study summarizes the presentation and outcome of a series of 12 patients with delayed intracerebral hemorrhage after VP shunt. Age ≥ 60 years, prior craniotomy operation and manipulation of the valve system are statistically significant to the delayed hematoma secondary to VP shunt.

Highlights

Cerebrospinal fluid (CSF) shunt procedures have dramatically reduced the morbidity and mortality of hydrocephalus, so the ventriculoperitoneal (VP) shunt is routinely used for CSF diversion
The delayed intracerebral hemorrhage was significantly related to age, prior craniotomy operation history and manipulation of valve system (3–7 days)
Neither gender sexuality nor potential risk factors for postoperative hemorrhage, time of shunt attempt affected the happen of delayed intracerebral hemorrhage

Summary

Introduction

Cerebrospinal fluid (CSF) shunt procedures have dramatically reduced the morbidity and mortality of hydrocephalus, so the ventriculoperitoneal (VP) shunt is routinely used for CSF diversion. Intracerebral hemorrhage in the ventricle or in the parenchyma along the catheter path within 24 hours after the operation is an uncommon complication. The mortality of delayed intracerebral hemorrhage is high, ranging from 50% to 100% [3, 5]. To improve clinical outcome of patients with delayed intracerebral hemorrhage after VP shunt, it may be important to understand the clinical features of the delayed intracerebral hemorrhage itself. We present clinical characteristics of the 12 patients with delayed intracerebral hemorrhage after VP shunt. Our data set has a uniquely large number of patients with delayed intracerebral hemorrhage, which enabled us to study the potential clinical risk factors and analyze the possible mechanisms. Delayed intracerebral hemorrhage after ventriculoperitoneal (VP) shunt insertion is rare and has not been well investigated previously.

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