Predictive factors for ventriculoperitoneal shunt placement in aneurysmatic subarachnoid hemorrhages.

Introduction: Aneurysmatic subarachnoid hemorrhages (aSAH) are life-threatening events with high mortality and morbidity. Hydrocephalus is a common complication, initially managed with an external ventricular drain (EVD). Persistent hydrocephalus often requires ventriculoperitoneal shunt (VPS) placement to relieve intracranial pressure and prevent further neurological damage.

Research question: What factors predict the need for VPS placement in patients with aSAH, and how does a new predictive model compare to the Mayo Age, Grades, EVD score (MAGE score)?

Materials and methods: A retrospective study of 105 patients with aSAH treated with EVD between 2014 and 2023 was conducted. Patients were divided into two groups: those requiring VPS (n= 45) and those not requiring VPS (n= 60). Sociodemographic, clinical, and treatment variables were analysed, and a new predictive model (SAH-VP) was developed and compared to the MAGE score.

Results: Patients who required VPS had higher WFNS scores on admission (p= 0.045), more infections requiring antibiotics (p= 0.002), more failed weaning attempts (p= 0.004), more failed closure attempts (p= 0.002), and longer EVD use (p< 0.01). The new SAH-VP model demonstrated an area under the curve (AUC) of 0.800.

Discussion and conclusion: There is no consensus on the factors predicting VPS need in SAH patients. This study identified key predictors and developed a new predictive model, SAH-VP, which could improve patient management by identifying those at higher risk of requiring VPS, offering an alternative to the existing MAGE score.