Abstract Details

In a retrospective study, we compared radiographic features on admission non-contrast head CTs of aSAH patients requiring a VPS to those who did not, at a referral academic center from 2016 through 2021. We calculated modified GRAEB scores and quantified total blood clot thickness (blood clot cisternal score) in the basal cisterns including interpeduncular, ambient, crural, prepontine, suprasellar, interhemispheric cisterns, and bilateral Sylvian fissures. Binary logistic regression tested the association of VPS requirement with radiographic features. Receiver operating characteristics (ROC) curve analysis was performed to compare predictive accuracy of cisternal score to other predictors.  

We included 176 patients (mean age of 54.9 years [SD 12.8]; 57% female, 70% white) of which 29 (16.5%) required a VPS for refractory hydrocephalus. Cisternal score was greater in patients who required a VPS than those who did not (median 61.6 mm, IQR 49.8-74.3 mm vs 26.8mm, IQR 12.4-46.7; p<0.001). Higher blood clot cisternal score was associated with higher odds of developing refractory hydrocephalus with VPS requirement (odds ratio 1.06 per each millimeter increase, 95% CI 1.03-1.09; p<0.001), independent of age, Hunt and Hess grades, and modified GRAEB scores. Blood clot cisternal score had higher accuracy in predicting VPS requirement than modified GRAEB score (AUC 0.83, 95% CI 0.74-0.93 vs AUC 0.72, 95% CI 0.63-0.82) and other clinical or radiographic predictors on admission.