• shunt
• neurosurgery
• neurochirurgia
• meta
• intracranial
• idrocefalo
• hydrocephalus
• hemorrhage
• subarachnoid
• cerebral
• aneurysm
• aneurisma
• subaracnoide

OBJECTIVE: The primary objective of this study was to determine the prevalence of CSF shunt dependency after subarachnoid hemorrhage due to intracranial aneurysm rupture in a comprehensive manner. The secondary objectives were to examine the relationship of shunt dependency with: (1) Fisher grade; (2) Hunt and Hess grade; (3) patient’s characteristics (age and sex); (4) aneurysm treatment; (5) acute hydrocephalus; (6) intraventricular hemorrhage.
METHODS: A comprehensive literature search of four databases (PubMed, Elsevier SCOPUS, Ovid EMBASE, and Web of Science) for articles published by January 2017 was conducted in accordance with PRISMA guidelines. A meta-analysis was performed and the graphical representation of the meta-analysis was presented by forest plot. The bias was analyzed by meta-regression, followed by Egger’s linear regression test. Heterogeneity of the data was assessed by the Higgins index, and subsequently the random-effects model.
RESULTS: A total of 25 articles and 19372 patients with SAH due to intracranial aneurysm rupture were included in this study. Based on the results of the meta-analysis, the prevalence rate for shunting was 23.6% (95% CI 19% - 28.2%). Factors for shunt dependency included acute hydrocephalus (OR 6.498, 95% CI 4.473 – 9.442), high Hunt and Hess Score (OR 3.552, 95% CI 3.054 – 4.132), intraventricular hemorrhage (OR 3.508, 95% CI 2.943 – 4.183), high Fisher grade (OR 3.259, 95% CI 2.679 – 3.965), over 50 years of age (OR 2.239, 95% CI 1.296 – 3.869), and female sex (OR 1.286, 95% CI 1.11 – 1.491), surgical clipping (OR 0.923, 95% CI 0.78 – 1.092).
CONCLUSIONS: The prevalence of shunt-dependent hydrocephalus was found to be 23.6% of SAH patients. Factors most associated with risk for shunt dependency are essentially related to the initial condition of the patient. These include, in descending order of significance, acute hydrocephalus, high Hunt and Hess Score, intraventricular hemorrhage, high Fisher grade, over 50 years of age, and female sex. All of which can be easily assessed upon admission by patient’s history, basic neurological examination, and computed tomography scan. The choice of treatment method for aneurysm obliteration had no influence on shunt dependency.