Currently, there is no established standard regarding the ideal number of external ventricular drain (EVD) clamp trials performed before ventriculoperitoneal (VP) shunt insertion following nontraumatic subarachnoid hemorrhage (SAH). In this study, the authors aimed to evaluate this relationship.
A retrospective review of all patients presenting with SAH between July 2007 and December 2016 was performed. Patients with SAH who had received an EVD within the first 24 hours of hospital admission and had undergone at least 1 clamp trial prior to EVD removal were eligible for inclusion in the study. Patient demographics, clinical presentations, SAH etiologies and grades, clamp trial data, hospital lengths of stay, and functional outcomes were recorded.
One hundred fourteen patients with nontraumatic SAH complicated by posthemorrhagic hydrocephalus were included in the study. The median patient age was 57 years (range 28–90 years), with a male/female ratio of 1:1.7. A ruptured aneurysm was the underlying etiology of SAH in 79.8% of patients. A majority of patients (69.4%) had a Hunt and Hess grade III–V on admission. The median number of clamp trials performed was 2 (range 1–6). A VP shunt was required in 40.4% of patients. In those who underwent 2 and 3 clamp trials, 60% and 38.9%, respectively, did not require subsequent VP shunt placement.
Surgical placement of a VP shunt is associated with complications. Clamp trials are routinely performed before making the decision to insert a shunt. In the present study, the authors found that a significant percentage of patients passed their second and third clamp trials without requiring subsequent shunt insertion. These data support performing multiple clamp trials prior to shunt placement.
ABBREVIATIONSCSF = cerebrospinal fluid; EVD = external ventricular drain; GCS = Glasgow Coma Scale; HH = Hunt and Hess; ICP = intracranial pressure; SAH = subarachnoid hemorrhage; VP = ventriculoperitoneal; WFNS = World Federation of Neurosurgical Societies.
Correspondence Ajith J. Thomas: Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA. firstname.lastname@example.org.
INCLUDE WHEN CITING Published online March 16, 2018; DOI: 10.3171/2017.10.JNS171644.
L.C.A. and R.G. contributed equally to this study and share first authorship.
Disclosures This research received no specific grant from any funding agency. The authors have no personal, financial, or institutional interest with regard to the authorship and/or publication of this manuscript.
ConnollyESJrRabinsteinAACarhuapomaJRDerdeynCPDionJHigashidaRT: Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke43:1711–173720122012
Di RoccoCMarcheseEVelardiF: A survey of the first complication of newly implanted CSF shunt devices for the treatment of nontumoral hydrocephalus. Cooperative survey of the 1991-1992 Education Committee of the ISPN. Childs Nerv Syst10:321–3271994
KlopfensteinJDKimLJFeiz-ErfanIHottJSGoslarPZabramskiJM: Comparison of rapid and gradual weaning from external ventricular drainage in patients with aneurysmal subarachnoid hemorrhage: a prospective randomized trial. J Neurosurg100:225–2292004
LewisAIrvineHOgilvyCKimberlyWT: Predictors for delayed ventriculoperitoneal shunt placement after external ventricular drain removal in patients with subarachnoid hemorrhage. Br J Neurosurg29:219–2242015