Luis C Ascanio1, Raghav Gupta1, Nimer Adeeb2, Justin M Moore1,3, Christoph J Griessenauer4, Julie Mayeku1, Yaw Tachie-Baffour1, Ranjit Thomas1, Abdulrahman Y Alturki1,5, Philip G R Schmalz6, Christopher S Ogilvy1, Ajith J Thomas1. 1. 1Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School. 2. 2Department of Neurosurgery, Louisiana State University, Shreveport, Louisiana. 3. 3Department of Neurosurgery, Boston Medical Center, Boston University, Boston, Massachusetts. 4. 4Department of Neurosurgery, Geisinger Medical Center, Danville, Pennsylvania. 5. 5Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia; and. 6. 6Department of Neurosurgery, University of Alabama at Birmingham Medical Center, Birmingham, Alabama.
Abstract
OBJECTIVE: Currently, there is no established standard regarding the ideal number of external ventricular drain (EVD) clamp trials performed before ventriculoperitoneal (VP) shunt insertion following nontraumatic subarachnoid hemorrhage (SAH). In this study, the authors aimed to evaluate this relationship. METHODS: A retrospective review of all patients presenting with SAH between July 2007 and December 2016 was performed. Patients with SAH who had received an EVD within the first 24 hours of hospital admission and had undergone at least 1 clamp trial prior to EVD removal were eligible for inclusion in the study. Patient demographics, clinical presentations, SAH etiologies and grades, clamp trial data, hospital lengths of stay, and functional outcomes were recorded. RESULTS: One hundred fourteen patients with nontraumatic SAH complicated by posthemorrhagic hydrocephalus were included in the study. The median patient age was 57 years (range 28-90 years), with a male/female ratio of 1:1.7. A ruptured aneurysm was the underlying etiology of SAH in 79.8% of patients. A majority of patients (69.4%) had a Hunt and Hess grade III-V on admission. The median number of clamp trials performed was 2 (range 1-6). A VP shunt was required in 40.4% of patients. In those who underwent 2 and 3 clamp trials, 60% and 38.9%, respectively, did not require subsequent VP shunt placement. CONCLUSIONS: Surgical placement of a VP shunt is associated with complications. Clamp trials are routinely performed before making the decision to insert a shunt. In the present study, the authors found that a significant percentage of patients passed their second and third clamp trials without requiring subsequent shunt insertion. These data support performing multiple clamp trials prior to shunt placement.
OBJECTIVE: Currently, there is no established standard regarding the ideal number of external ventricular drain (EVD) clamp trials performed before ventriculoperitoneal (VP) shunt insertion following nontraumatic subarachnoid hemorrhage (SAH). In this study, the authors aimed to evaluate this relationship. METHODS: A retrospective review of all patients presenting with SAH between July 2007 and December 2016 was performed. Patients with SAH who had received an EVD within the first 24 hours of hospital admission and had undergone at least 1 clamp trial prior to EVD removal were eligible for inclusion in the study. Patient demographics, clinical presentations, SAH etiologies and grades, clamp trial data, hospital lengths of stay, and functional outcomes were recorded. RESULTS: One hundred fourteen patients with nontraumatic SAH complicated by posthemorrhagic hydrocephalus were included in the study. The median patient age was 57 years (range 28-90 years), with a male/female ratio of 1:1.7. A ruptured aneurysm was the underlying etiology of SAH in 79.8% of patients. A majority of patients (69.4%) had a Hunt and Hess grade III-V on admission. The median number of clamp trials performed was 2 (range 1-6). A VP shunt was required in 40.4% of patients. In those who underwent 2 and 3 clamp trials, 60% and 38.9%, respectively, did not require subsequent VP shunt placement. CONCLUSIONS: Surgical placement of a VP shunt is associated with complications. Clamp trials are routinely performed before making the decision to insert a shunt. In the present study, the authors found that a significant percentage of patients passed their second and third clamp trials without requiring subsequent shunt insertion. These data support performing multiple clamp trials prior to shunt placement.
Authors: David Y Chung; DaiWai M Olson; Sayona John; Wazim Mohamed; Monisha A Kumar; Bradford B Thompson; Guy A Rordorf Journal: Curr Neurol Neurosci Rep Date: 2019-11-26 Impact factor: 5.081
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Authors: David Y Chung; Bradford B Thompson; Monisha A Kumar; Ali Mahta; Shyam S Rao; James H Lai; Aleksey Tadevosyan; Kathryn Kessler; Joseph J Locascio; Aman B Patel; Wazim Mohamed; DaiWai M Olson; Sayona John; Guy A Rordorf Journal: Neurocrit Care Date: 2021-09-08 Impact factor: 3.532