Efficacy of lumbo-peritoneal versus ventriculo-peritoneal shunting for management of chronic hydrocephalus following aneurysmal subarachnoid haemorrhage

Abstract

Background: The clinical usefulness of lumboperitoneal (LP) shunts in selecting patients with communicating hydrocephalus after aneurysmal subarachnoid haemorrhage (SAH) was compared with that of ventriculoperitoneal (VP) shunts.

Method: Chronic hydrocephalus was defined as clinically and radiographically demonstrated hydrocephalus which lasted 3 weeks or longer after the original haemorrhage and which required shunting. Indications for a CSF shunt were assessed on the basis of neurological symptoms and signs, CT findings, and isotope cisternogram findings. The patients were treated with either LP or VP shunts. A significant response to shunting was defined as an improvement of function to a higher grade. The functioning of the shunt was evaluated by the location of the catheter on x-ray studies, CT features, and isotope cisternograms. The operation groups were checked for comparability of demographic and clinical variables including age, Fisher grade, hypertension, vasospasm, shunt interval, preshunt functional grade, and CT findings. A comparative analysis of the outcome was carried out between the two operation groups.

Findings: Fifty-six patients underwent shunt placements (LP shunts: 22, VP shunts with medium pressure valve: 2, VP shunts with high pressure valve: 32). There was no statistically significant difference in patient demographics and clinical characteristics between the patients with LP shunts and those with VP shunts. A follow-up time of 3 months to 8 years revealed clinical improvement in 11 cases (50.0%) of patients with LP shunts and 31 cases (91.1%) in VP shunts was seen (Fisher's exact test, P<0.005).

Interpretation: These findings suggest that VP shunts are a better choice of treatment than LP shunts in treating chronic hydrocephalus after aneurysmal SAH.