• World Neurosurg · Jan 2019

    The role of cerebrospinal fluid markers for predicting shunt dependent hydrocephalus in patients with subarachnoid hemorrhage and external ventricular drain placement.

    • Markus Lenski, Annamaria Biczok, Volker Huge, Robert Forbrig, Josef Briegel, Jörg-Christian Tonn, and Niklas Thon.
    • Neurochirurgische Klinik und Poliklinik, Klinikum Großhadern, Ludwig Maximilian Universität, Munich, Germany. Electronic address: markus.lenski@med.uni-muenchen.de.
    • World Neurosurg. 2019 Jan 1; 121: e535-e542.

    ObjectiveWe sought to identify potential risk factors for the development of shunt-dependent chronic hydrocephalus after aneurysmal subarachnoid hemorrhage (SAH) and external ventricular drain (EVD) insertion. In particular, the role of inflammatory markers within the cerebrospinal fluid (CSF) was assessed.MethodsFor this single-center analysis, data were generated from consecutive patients with SAH and the need for EVD implantation treated on our neurosurgical intensive care unit between 2013 and 2015. Parameters were patient characteristics (age, sex, comorbidity), severity of SAH (according to the World Federation of Neurological Society score), imaging findings (intraventricular hemorrhage, diameter of the third ventricle, location of the ruptured aneurysm), and acute course of disease (cerebral infarction, vasospasm). Moreover, the impact of EVD drainage volume and CSF markers (total protein [CSFTP], red blood cell count [CSFRBC], interleukin-6 [CSFIL-6], and glucose [CSFGlc]) was assessed. Statistics including receiver-operating-curve with corresponding area-under-the-curve (AUC) analysis were calculated using SPSS.ResultsOverall, 63 patients (21 males, mean age 55.2 years) were included. Twenty-one patients (30%) developed a shunt-dependent hydrocephalus. Significant risk factors for shunt dependency were the World Federation of Neurological Society score, cerebral infarction, and diameter of the third ventricle (P < 0.05). Moreover, CSF markers associated with shunt-dependent hydrocephalus included increased levels of CSFTP on days 5 (AUC = 0.72)/11 (AUC = 0.97)/14 (AUC = 0.98), CSFIL-6 on day 14 (AUC = 0.81), and CSFRBC on day 15 (AUC = 0.83). The EVD drainage volume was not prognostic.ConclusionsThe time course of selected inflammatory markers in CSF may support management considerations in the early phase after SAH and critical impairment of CSF circulation.Copyright © 2018 Elsevier Inc. All rights reserved.

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