Role of Ventriculoperitoneal Shunt for Haemorrhagic or Ischemic Strokes Causing Hydrocephalus

Abstract

Posterior fossa hemorrhagic involve or infract associated hydrocephalus are serious neurosurgical emergencies which requires immediate and prompt action.
Purpose: To highlight the role of VP shunt in the management plan of Hydrocephalus caused by spontaneous hemorrhagic or ischemic infarcts.
Material and Methods: This is retrospective study of 16 cases over a period of 4 years from March 2007 to March 2011 conducted simultaneously at Neurosurgical departments of CMH Lahore, CMH Multan and Farooq Hospital Lahore.
Results: A total of 16 cases were included in this study and all those patients underwent some sort of CSF diversion procedure for obstructive hydrocephalus. Ten Patients (62.5%) were male and six (37.5%) patients were female. The age ranged from 32 – 70 years with mean age of 53.4 years. Clinically all patients presented with headache, vomiting and neck pain followed by loss of consciousness. Glasgow coma scale ranged from 5/15 to 12/15. The radiological findings were those of hemorrhagic or ischemic infarcts causing obstructive hydro-cephalus. Patients were broadly divided into two main groups with eight patients in each group. Group A inclu-ded 6 males and 2 females, all these patients were managed conservatively for the hemorrhagic or ischemic strokes while they underwent VP Shunt for the obstructive hydrocephalus. Two of these patients (a male and a female) had thalamic bleed (hemorrhagic stroke) with third ventricular blockade. These two patients were also managed by VP Shunt only. Outcome of patients in group A was excellent in 7 patients whereas one patients developed complications with prolonged hospital stay but ultimately recovered and discharged. Group B inclu-ded 8 patients (4 male and 4 female) who underwent hematoma evacuation of cerebellar bleed along with place-ment of external ventricular drain (EVD). EVD was converted to VP Shunt in six patients when they deteriorated after blocking EVD on 5th post operative day. 2 patients out of these eight did not deteriorate on EVD blockade and VP Shunt was not passed in these patients and they had excellent recovery. One patient died in group B. One patient required redo surgery due to Shunt Blockade and had poor recovery whereas two more patients had poor recovery due to other reasons including poor neurological status pre operatively. Two patients had fairly good recovery after converting EVD into VP Shunt.
Conclusion: Obstructive hydrocephalus caused by hemorrhagic stroke or infarcts is a relatively rare entity requiring some sort of CSF diversion. Patients who are having smaller hematomas with hydrocephalus and GCS more than 8/15 can be managed with VP Shunt alone.