Risk Factors for Ventriculoperitoneal Shunt Dependency in Patients with Spontaneous Cerebellar Hemorrhage

Background

Hydrocephalus is a common complication after spontaneous cerebellar hemorrhage (CH). This study focused on predicting ventriculoperitorneal (VP) shunt dependency in patients with spontaneous CH.

Methods

Ninety-nine patients with spontaneous CH were evaluated in this retrospective study. A comparison between patients with and those without VP shunt dependency during hospitalization was made.

Results

VP shunt–dependent hydrocephalus developed in 19.2% of the patients (19 of 99). Comparison of neuroimaging findings on admission between the 2 patient groups identified large hematoma dimension (P < 0.001), large hematoma volume (P = 0.001), fourth ventricular degradation (P < 0.001), development of hydrocephalus (P < 0.001), and obliteration of the basal cisterns (P < 0.001) as significant risk factors for VP shunt–dependent hydrocephalus. Stepwise logistic regression analysis identified hydrocephalus on admission and maximum hematoma diameter on admission as independent risk factors for VP shunt dependency (P = 0.006 and 0.020, respectively). The adjusted risk of VP shunt dependency for patients with hydrocephalus on admission had an odds ratio of 37.04. Furthermore, an increase of 1 mm in the blood clot diameter on admission would increase the VP shunt dependency rate by 11.9%. The cutoff value of blood clot diameter on presentation was 36.15 mm (sensitivity, 84.2%; specificity, 85.0%).

Conclusions

A patient with hydrocephalus on admission and a hematoma of larger size and dimension at the time of initial imaging is at elevated risk for VP shunt dependency. Repeat neuroimaging studies and careful clinical assessment are mandatory for high-risk patients to determine the presence of post-CH hydrocephalus.

Introduction

Spontaneous cerebellar hemorrhage (CH) accounts for 5%–13% of all cases of spontaneous intracranial hemorrhage.1, 2, 3, 4, 5, 6, 7 The reported mortality rate for patients with CH ranges from 20% to 75%, and the overall surgical mortality rate remains as high as 20%–50%.2, 4, 8, 9, 10, 11 An important neurologic complication is posthemorrhagic hydrocephalus, which can be either of acute onset and present on admission or of late onset, developing during the hospital stay. The reported overall risk of hydrocephalus after spontaneous CH ranges from 40% to 70%.12, 13, 14 The overall incidence of shunt malfunction is 15.4%.¹⁵ To the best of our knowledge, to date no clinical study has focused specifically on predicting shunt dependency in patients with spontaneous CH. Because of the possible benefits of therapeutic intervention, there is a need for better delineation of the potential risk factors and clinical features in this specific subgroup. This retrospective study aimed to analyze the clinical features, neuroimaging findings, and clinical scores and measurements to identify the potential risk factors that are predictive of shunt-dependent hydrocephalus in patients with spontaneous CH.