Role of EVD Placement in Patients with Hydrocephalus Secondary to Subarachnoid Hemorrhage and Need for Permanent Ventriculoperitoneal Shunt Placement

Abstract

Background: Subarachnoid hemorrhage (SAH), often caused by aneurysm rupture, is a critical neurosurgical condition frequently leading to hydrocephalus. Management typically involves the use of an external ventricular drain (EVD) to reduce intracranial pressure and drain cerebrospinal fluid (CSF). The transition from EVD to permanent ventriculoperitoneal shunt (VPS) placement is a pivotal decision in patient management, influenced by various factors. Objective: This study aims to analyze the role of EVD placement in patients with hydrocephalus secondary to spontaneous SAH and the subsequent need for permanent VPS placement. Methods: Conducted at Jinnah Postgraduate Medical Center, Karachi, over six months, this retrospective study included 30 patients. After securing hospital ethical committee approval, several parameters were recorded: age, gender, Glasgow Coma Scale (GCS) score, aneurysm details (size and location), vasospasm occurrence, EVD placement in ICU, duration of EVD placement, CSF output, clamp trials, and wean failures. Results: Out of 30 patients, 8 (26.66%) required VPS placement. No significant difference was found in VPS placement regarding age, gender, GCS score, aneurysm treatment and location, vasospasm, and EVD placement in ICU. However, patients requiring VPS had statistically longer EVD duration (p=0.0001), larger aneurysm size, more wean trials, clamp trials, and instances of wean failure (p=0.0001). Conclusion: The study highlights the complexities in managing hydrocephalus post-SAH, particularly the significant association between the need for VPS installation and factors like EVD duration, aneurysm size, and wean trial outcomes. It underscores the need for future prospective studies with larger sample sizes to better identify patients who would benefit from shunt insertion post-SAH. Keywords: EVD, Hydrocephalus, SAH, Ventriculoperitoneal Shunt, Wean Trials.