Endoscopic third ventriculostomy may decrease shunt-dependency in patients with post-hemorrhagic hydrocephalus following aneurysmal subarachnoid hemorrhage

Abstract

ObjectiveVentriculoperitoneal shunting (VPS) is associated with high complication rates. Here, we investigate whether endoscopic third ventriculostomy (ETV) can reduce shunt-dependency in patients suffering from hydrocephalus following aneurysmal subarachnoid hemorrhage (aSAH). MethodsA retrospective study was conducted. Twelve consecutive patients underwent ETV as a primary method of surgical treatment from May 2015 to December 2019. Data was obtained from the electronic medical record. The mean follow-up time was 111 days. ResultsETV provided immediate radiographic resolution of hydrocephalus in all patients. Seven patients (58.3%) showed no clinical or radiographic signs of hydrocephalus at a mean interval of 5.4 months following ETV. The remaining 5 patients demonstrated recurrent hydrocephalus at a mean interval of 41 days, with one death due to complications of an ischemic stroke unrelated to ETV. The remaining 4 underwent frontal VPS at a mean interval of 8 days following ETV failure. A decreased number of EVD wean trials (1.0 ± 0.53 vs 1.8 ± 0.40, p = 0.011) was associated with ETV success. Factors showing a trend towards ETV success included smaller degree of vasospasm and decreased cerebrospinal fluid (CSF) protein content. The presence of intraventricular hemorrhage, Hunt and Hess score and Fisher grade were not associated with ETV success. ConclusionETV may offer a viable alternative to VP shunting in the treatment of post-hemorrhagic hydrocephalus following aSAH. Degree of vasospasm, failure to wean external ventriculostomy, and CSF protein levels appear to influence the success of ETV as a standalone intervention versus those patients requiring shunt placement.