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Trends in Utilization of Temporary and Permanent Cerebrospinal Fluid Diversion and Catheter Cerebral Angiography for Patients with Aneurysmal Subarachnoid Hemorrhage in the United States


Abstract

Introduction

Aneurysmal subarachnoid hemorrhage (aSAH) pools blood into the subarachnoid space and may extend into the cerebrospinal fluid (CSF) ventricles, elevating intracranial pressure. This requires permanent CSF diversion achieved by external ventricular drainage (EVD) and sometimes followed by a ventriculoperitoneal shunt (VPS) if the patient develops hydrocephalus. Although predictors of EVD failure requiring VPS shunting are well-established, we sought to analyze the relationship in the utilization of the two in a nationally representative cohort.

Methods

The Nationwide Inpatient Sample database was queried from 2006 to 2018 for patients with aSAH who underwent clipping or coiling. Patients who received EVD and VPSs were also identified. Cochrane Armitage test was conducted to assess the linear trend of proportions of EVDs and VPSs per year.

Results

A total of 133,566 admissions were identified from 2006 to 2018 involving aSAH. Of these, 55,859 (41.82%) received  EVDs, and 14,125 (10.58%) with VPSs. There was an average upward trend of 1.57% in EVD utilization; There was no trend seen in VPS utilization (trend: -0.06%; p=0.44).

Conclusion

Although there was an increase in the utilization of EVDs for aSAH over the years, there was an underutilization of VPSs. Previous literature demonstrates that VP shunts have higher rates of complications, and shunt dependency after aSAH raises the likelihood of morbidity and mortality. The underutilization of VPS needs to be explored further, but this phenomenon may be due to the improvement in CSF diversion management.

Poster
non-peer-reviewed

Trends in Utilization of Temporary and Permanent Cerebrospinal Fluid Diversion and Catheter Cerebral Angiography for Patients with Aneurysmal Subarachnoid Hemorrhage in the United States


Author Information

Tessa Breeding Corresponding Author

Neurological Surgery, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Davie, USA

Waseem Wahood

Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Davie, USA

Zayn Mohamed

Neurosurgery, University of South Florida Morsani College of Medicine, Tampa, USA

Ali S. Haider

Health Science Center, Scott & White Clinic, Houston , USA

Giuseppe Lanzino

Neurological Surgery, Mayo Clinic, Rochester, USA

Waleed Brinjikji

Neuroradiology, Mayo Clinic, Rochester, MN, USA

Alejandro Rabinstein

Neurology, Mayo Clinics, Rochester Mn, Rochester, USA


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