The feasibility of lumboperitoneal shunting for hydrocephalus after endovascular coil embolization of aneurysmal subarachnoid hemorrhage

Objective: We retrospectively analyzed the clinical usefulness of lumboperitoneal (LP) shunt placement surgery for chronic hydrocephalus after aneurysmal subarachnoid hemorrhage (SAH). Methods: A total of 225 patients underwent endovascular coiling for aneurysmal SAH at our institution between April 2007 and May 2012. Of these, the medical records of 190 consecutive patients were retrospectively analyzed for hydrocephalus incidence, shunt procedure-related complication rate, and hydrocephalus improvement rate. Of the 190 cases included for analysis, 102 were classified as Hunt and Hess (H and H) grades 1–2 (low H and H grade) and 88 as grades 3–5 (high H and H grade). Forty-nine cases were classified as Fisher group 1–2 (low Fisher group) and 141 as groups 3–4 (high Fisher group), which included five Fisher group 4 patients. Results: Of the 190 patients analyzed, 22 (11.6%) presented with chronic hydrocephalus and underwent shunt placement surgery. A severe H and H grade (grade 3–5) and high Fisher group (group 3–4) were significant risk factors for chronic hydrocephalus. Twelve LP shunt surgeries and ten ventriculoperitoneal (VP) shunt surgeries were performed. All patients showed symptom improvement as confirmed by imaging results. In the LP shunt group, there were no procedure-related complications. One patient in the VP shunt group developed ventricular hemorrhage and one patient in each group developed a postoperative infection. Conclusion: LP shunting, which is considered relatively less invasive, yielded similar results as VP shunting; therefore, it may be an option for managing chronic hydrocephalus after endovascular treatment for SAH.