AUTHOR=Khalaveh Farjad , Zeiser Vitalij , Cho Anna , Schmelzer Sophie , Reinprecht Andrea , Herta Johannes , Roessler Karl , Dorfer Christian 

TITLE=Predicting the need for cerebrospinal fluid shunt implantation after spontaneous intracerebral hemorrhage: a challenging task

JOURNAL=Frontiers in Neurology

VOLUME=14

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1255477

DOI=10.3389/fneur.2023.1255477

ISSN=1664-2295

ABSTRACT=<sec id="sec1"><title>Objectives</title><p>The development of persistent hydrocephalus in patients after spontaneous intracerebral hemorrhage (ICH) is still poorly understood, and many variables predicting the need for a cerebrospinal fluid (CSF)-shunt have been described in the literature with varying results. The aim of this study is to find predictive factors for shunt dependency.</p></sec><sec id="sec2"><title>Methods</title><p>We performed a retrospective, single-center study of 99 neurosurgically treated patients with spontaneous ICH. Variables, including age, Glasgow Coma Scale (GCS), intraventricular hemorrhage (IVH), location of hemorrhage, acute hydrocephalus, and volumetric analysis of IVH, ICH, and intraventricular CSF were compared between patients with and without CSF-shunt implantation. Furthermore, receiver operating characteristics (ROC) for ICH, IVH, and intraventricular CSF volume parameters were calculated.</p></sec><sec id="sec3"><title>Results</title><p>CSF-shunt implantation was performed significantly more often in patients after thalamic (<italic>p</italic> = 0.03) and cerebellar ICH (<italic>p</italic> = 0.04). Moreover, a lower ratio between the total hemorrhage volume and intraventricular CSF volume (<italic>p</italic> = 0.007), a higher IVH distribution in the third ventricle, and an acute hydrocephalus (<italic>p</italic> &lt; 0.001) with an increased intraventricular CSF volume (<italic>p</italic> &lt; 0.001) were associated with shunt dependency. Our ROC model demonstrated a sensitivity of 82% and a specificity of 65% to predict the necessity for a shunt at a cutoff value of 1.9 with an AUC of 0.835.</p></sec><sec id="sec4"><title>Conclusion</title><p>Volumetric analysis of ICH, IVH, and intraventricular CSF may improve the prediction of CSF shunt implantation in patients with spontaneous ICH.</p></sec>