Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Mar 16;130(3):956-962.
doi: 10.3171/2017.10.JNS171644.

Relationship Between External Ventricular Drain Clamp Trials and Ventriculoperitoneal Shunt Insertion Following Nontraumatic Subarachnoid Hemorrhage: A Single-Center Study

Affiliations

Relationship Between External Ventricular Drain Clamp Trials and Ventriculoperitoneal Shunt Insertion Following Nontraumatic Subarachnoid Hemorrhage: A Single-Center Study

Luis C Ascanio et al. J Neurosurg. .

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.

Keywords: CSF = cerebrospinal fluid; EVD = external ventricular drain; GCS = Glasgow Coma Scale; HH = Hunt and Hess; ICP = intracranial pressure; SAH = subarachnoid hemorrhage; VP = ventriculoperitoneal; WFNS = World Federation of Neurosurgical Societies; clamp trials; external ventricular drain; hydrocephalus; subarachnoid hemorrhage; vascular disorders; ventriculoperitoneal shunt.

Similar articles

See all similar articles

Cited by 1 article

LinkOut - more resources

Feedback