Ventricular Volume Change as a Predictor of Shunt-Dependent Hydrocephalus in Aneurysmal Subarachnoid Hemorrhage.

Abstract Background Hydrocephalus is a common complication of aneurysmal subarachnoid hemorrhage (aSAH) often requiring placement of an external ventricular drain (EVD) acutely. Current systems for determining which patients require long-term cerebrospinal fluid diversion remain subjective. Objective We investigate ventricular volume change after EVD clamping as an objective predictor of shunt dependence in patients with aSAH. Methods Retrospective chart review and image analysis of patients treated for aSAH at a single academic institution who required EVD placement for acute hydrocephalus and underwent one EVD weaning trial. Head CTs obtained prior to and after EVD clamping were analyzed using a custom semi-automated MATLAB program which segments each CT into five tissue types using k-means clustering. Differences in the pre-and post-clamp ventricular volumes (ΔVV) were calculated. Results Thirty-four shunted patients met inclusion criteria and were sex- and age- matched to thirty-four non-shunted controls. The mean ΔVV was 19.8 mL in the shunted patients and 3.8 mL in the non-shunted patients (p Conclusions Change in ventricular volume between head CTs taken pre- and post-EVD clamping were predictive of early and delayed shunt dependence.