Shunt-Dependent Hydrocephalus and Cognitive Outcomes After Aneurysmal Subarachnoid Hemorrhage.
4 affiliations
- 1Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
- 2Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
- 3Neurovascular Surgery, Community Neurological Institute and Community Health Partners, Community Regional Medical Center, Fresno, California, USA.
- 4Division of Neurosurgery, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada.
Abstract
Background and objectives
Hydrocephalus is a common complication after aneurysmal subarachnoid hemorrhage (aSAH), frequently requiring permanent cerebrospinal fluid (CSF) diversion. The relationship between chronic, shunt-dependent hydrocephalus and cognitive outcomes after aSAH remains poorly defined. This study evaluated whether patients requiring permanent CSF diversion demonstrate worse cognitive outcomes at 90 days after aSAH.Methods
A post hoc analysis of the multicenter NEWTON-2 clinical trial data set was conducted. Patients with ruptured saccular aneurysms (World Federation Neurosurgical Societies 2-4) who had Montreal Cognitive Assessment (MoCA) scores available at 90 days were included. Patients undergoing ventriculoperitoneal shunt placement were classified as having chronic hydrocephalus. The primary outcome was MoCA score at 90 days. Negative binomial regression was used to model MoCA scores, and logistic regression was performed using a clinically validated cutoff for cognitive impairment (MoCA ≤25). Multivariable models adjusted for age, sex, hypertension, World Federation Neurosurgical Societies grade, and delayed cerebral ischemia.Results
Among 215 patients with available 90-day MoCA scores, 77 (36%) required permanent CSF diversion. Median MoCA scores were lower in shunted patients compared with nonshunted patients (24 [IQR 16-26] vs 26 [IQR 22-28], P = .0007). Shunt placement was independently associated with increased odds of cognitive impairment at 90 days (odds ratio 2.13, 95% CI, 1.11-4.14) and an approximately 2.7-point reduction in MoCA scores after adjustment for covariates.Conclusion
Permanent CSF diversion after aSAH is independently associated with worse cognitive performance at 90 days. Shunt-dependent hydrocephalus may identify patients at increased risk for persistent cognitive impairment who may benefit from enhanced monitoring and targeted rehabilitation.
Related
- Development and Validation of an Early Postoperative Risk Stratification Model for Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage.
- Aneurysmal Subarachnoid Hemorrhage Associated with Diabetic Ketoacidosis in a Patient with Insulin-Dependent Diabetes: An Autopsy Case Report
- Do Early Prognostic Measures Differentiate Mechanisms of ICU Death in Aneurysmal Subarachnoid Hemorrhage? An Analysis of Fatal Outcomes
- Non-aneurysmal perimesencephalic subarachnoid hemorrhage in a middle-aged female possibly triggered by Valsalva-like event and uncontrolled hypertension: a case report
- Interventional Rescue Therapy for Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage: 10-Year Experience
BibTeX
@article{rossong2026shuntdependent,
title = {{Shunt-Dependent Hydrocephalus and Cognitive Outcomes After Aneurysmal Subarachnoid Hemorrhage.}},
author = {Heather Rossong and Catherine Veilleux and Robert Loch Macdonald and Matthew E Eagles},
journal = {Neurosurgery practice},
year = {2026},
month = oct,
doi = {10.1227/neuprac.0000000000000310},
url = {https://europepmc.org/article/MED/42910116},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Shunt-Dependent Hydrocephalus and Cognitive Outcomes After Aneurysmal Subarachnoid Hemorrhage.
AU - Heather Rossong
AU - Catherine Veilleux
AU - Robert Loch Macdonald
AU - Matthew E Eagles
PY - 2026
DA - 2026/10/23
JO - Neurosurgery practice
DO - 10.1227/neuprac.0000000000000310
UR - https://europepmc.org/article/MED/42910116
AB - Background and objectives Hydrocephalus is a common complication after aneurysmal subarachnoid hemorrhage (aSAH), frequently requiring permanent cerebrospinal fluid (CSF) diversion. The relationship between chronic, shunt-dependent hydrocephalus and cognitive outcomes after aSAH remains poorly defined. This study evaluated whether patients requiring permanent CSF diversion demonstrate worse cognitive outcomes at 90 days after aSAH.Methods A post hoc analysis of the multicenter NEWTON-2 clinical trial data set was conducted. Patients with ruptured saccular aneurysms (World Federation Neurosurgical Societies 2-4) who had Montreal Cognitive Assessment (MoCA) scores available at 90 days were included. Patients undergoing ventriculoperitoneal shunt placement were classified as having chronic hydrocephalus. The primary outcome was MoCA score at 90 days. Negative binomial regression was used to model MoCA scores, and logistic regression was performed using a clinically validated cutoff for cognitive impairment (MoCA ≤25). Multivariable models adjusted for age, sex, hypertension, World Federation Neurosurgical Societies grade, and delayed cerebral ischemia.Results Among 215 patients with available 90-day MoCA scores, 77 (36%) required permanent CSF diversion. Median MoCA scores were lower in shunted patients compared with nonshunted patients (24 [IQR 16-26] vs 26 [IQR 22-28], P = .0007). Shunt placement was independently associated with increased odds of cognitive impairment at 90 days (odds ratio 2.13, 95% CI, 1.11-4.14) and an approximately 2.7-point reduction in MoCA scores after adjustment for covariates.Conclusion Permanent CSF diversion after aSAH is independently associated with worse cognitive performance at 90 days. Shunt-dependent hydrocephalus may identify patients at increased risk for persistent cognitive impairment who may benefit from enhanced monitoring and targeted rehabilitation.
SN - 2834-4383
ER -