Lumbar Drainage and Low Rate of Permanent Shunt Insertion after Treating Aneurysmal Subarachnoid Hemorrhage
Teerapat Boonyawanakij MD*, Wuttipong Tirakotai MD, MSc, Dr.med**, Anusak Liengudom MD**
Affiliation : * Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand ** Department of Neurosurgery, Prasat Neurological Institute, Bangkok, Thailand
Objective : This study investigated the predictive factors contributing to shunt-dependent hydrocephalus and the rate of shunt
requirement in a ruptured aneurysmal subarachnoid hemorrhage. The factors related to short-term clinical outcomes were
also determined.
Material and Method: A retrospective review was conducted of 200 patients who underwent surgical clipping of ruptured
aneurysmal subarachnoid hemorrhage based on protocols of CSF drainage at Prasat Neurological Institute (PNI) between
January 2008 and February 2010. Patient demographic, Glasgow Coma Score (GCS), Hunt and Hess (H&H) grade,
Fisher’s grade and Glasgow Outcome Scale (GOS) were evaluated. The rate of shunt requirement was analyzed. PNI score
was designed for predicting shunt requirement.
Results : Two hundred patients who underwent surgical clipping aneurysm consisted of 86 males and 114 females aged
ranging from 34-78 years (Mean 56 years). The patients were divided into two groups by treatment protocols; 164 patients
(82%) in the first group were operated using supraorbital craniotomy (SOC) with a pre-operative spinal drain. Thirty-six
patients (18%) in the second group were operated using mini-open craniotomy and without pre-operative spinal drain. Three
patients (1.5%) required a permanent shunts and all of them had full PNI Score (PNI score = 7) (p<0.001). In all, 189 patients
(94.5%) with high preoperative GCS 9 (p<0.001) had satisfactory surgical outcomes (GOS 4&5).
Conclusion : This study demonstrated the decreased rate of permanent shunts in patients with ruptured aneurysmal SAH who
were treated under the PNI protocol. A factor that effectively predicted shunt-dependency was the PNI score equivalent to 7.
Keywords : Rupture aneurysm, SAH, Permanent shunt, Clinical outcome
