Ventriculoperitoneal shunt for hydrocephalus after aneurysmal subarachnoid hemorrhage
Ventriculoperitoneal shunt should be the main treatment for hydrocephalus after aneurysmal subarachnoid hemorrhage, but ETV can be employed as a temporary intervention in certain conditions, such as during the waiting period for the clearance of aneurysmal subarachnoid hemorrhage 1).
Shunt-dependent hydrocephalus after aSAH is associated with higher morbidity and mortality, and prediction modeling of shunt dependency is feasible with clinically useful yields. It is important to identify and understand the factors that increase risk of shunting and to eliminate or mitigate the reversible factors. The aSAH-PARAS Consortium (Aneurysmal Subarachnoid Hemorrhage Patients' Risk Assessment for Shunting) has been initiated to pool the collective insights and resources to address key questions in post-aSAH shunt dependency to inform future aSAH treatment guidelines 2).
Patients who had NPH due to poor-grade aSAH would benefit from shunt placement when given the correct candidates and timely management of shunt malfunction. Additionally, the curative effect of the shunt should have been regarded as a long-term goal of rehabilitation in these patients 3).
Although Little et al. currently use a proactive shunting paradigm for posthemorrhagic hydrocephalus, a report demonstrates that a conservative approach to patients with borderline ventricle size (i.e., RBCI of 1.0-1.4) and normal intracranial pressure should be evaluated in a prospective randomized trial 4).