Relationship between external ventricular drain clamp trials and ventriculoperitoneal shunt insertion following nontraumatic subarachnoid hemorrhage: a single-center study

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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.

ABBREVIATIONS CSF = 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.

Article Information

Correspondence Ajith J. Thomas: Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA.

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.

© AANS, except where prohibited by US copyright law.







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