Clinical characteristics and risk factors of delayed intracranial hemorrhage after ventriculoperitoneal shunt in traffic hydrocephalus

Abstract

Objective To analyze the clinical features and risk factors of delayed intracranial hemorrhage (DICH) after ventriculoperitoneal shunt (VPS) in patients with communicating hydrocephalus. Methods One hundred and seventy-six patients with ventriculoperitoneal shunt due to communicating hydrocephalus secondary to craniocerebral trauma, hypertensive intracerebral hemorrhage, brain tumor or intracranial aneurysm rupture hemorrhage, admitted to our hospital from January 2012 to August 2018, were selected in our study; these patients were divided into DICH group and non-DICH group according to whether or not DICH occurred. The clinical features, including incidence, time and location of DICH, were analyzed. The differences of age, gender, length of stay, concomitant diseases, previous operation history, incidences of subdural effusion and puncture canal edema after ventriculoperitoneal shunt, and history of down-regulating shunt valve within 2 weeks between the two groups were compared by univariate analysis. The independent risk factors for DICH were further assessed using multivariable Logistic regression. Results Among 176 patients, 23 (13.07%) had DICH; 2-11 d after surgery, DICH appeared, manifesting as subdural, ventriculoventricular end canal and/or hemorrhage in one or more areas of the ventricle. There were significant differences in incidence of subdural effusion and history of down-regulating shunt valve within 2 weeks between the two groups (P<0.05). Multivariate Logistic regression analysis showed that subdural effusion after surgery and down-regulation of shunt valve pressure within 2 weeks after ventriculoperitoneal shunt were independent risk factors for DICH (OR=4.516, 95%CI: 1.555-13.110, P=0.006; OR=5.352, 95%CI: 1.987-14.414, P=0.001). Conclusion High incidence of DICH mighty be noted within two weeks of ventriculoperitoneal shunt; subdural effusion and pressure reduction of shunt valve within 2 weeks are independent risk factors for DICH, which needs close monitoring and clinical intervention. Key words: Delayed intracranial hemorrhage; Communicating hydrocephalus; Ventriculoperitoneal shunt; Risk factor