External ventricular drainage response in poor grade aneurysmal subarachnoid hemorrhage: Effect on preoperative grading and prognosis

Evan R. Ransom, J. Mocco, Ricardo J. Komotar, Deshdeepak Sahni, Jennifer Chang, David K. Hahn, Grace H. Kim, J. Michael Schmidt, Robert R. Sciacca, Stephan A. Mayer, E. Sander Connolly

Research output: Contribution to journalArticlepeer-review

52 Scopus citations


Introduction: The importance of preoperative response to external ventricular drainage (EVD) for treatment of acute hydrocephalus (HCP) following poor grade (Hunt & Hess grade IV or V) aneurysmal subarachnoid hemorrhage (aSAH) has not been clearly defined. The effect of EVD response on preoperative grade and prognosis is described. Methods: Fifty-nine poor grade patients had an EVD placed preoperatively and underwent definitive aneurysm treatment between September 1996 and March 2002. Patients improving ≥ one Hunt and Hess grade were considered responders. Case-control comparisons were completed for each responder, based on clinical grade; the pre-EVD grade and the post-EVD (response) grade were used to generate two independent control cohorts. Logistic regression was used to evaluate the relationship of 12-month modified Rankin disability score (mRS) to clinical grade. Results: Nineteen (32%) responders were identified, and were less likely Grade V (p < 0.05), and more often had smaller (<13 mm, p < 0.01) and posterior circulation (p < 0.03) aneurysms. The frequency of favorable outcome (mRS ≤ 3) was greater in responders than non-responders (68% vs. 28%, p < 0.001). Responders had a similar incidence of favorable outcome as response-grade controls (74%), and a higher incidence of favorable outcome than pre-EVD controls (47%). Regression analysis identified the post-EVD grade, but not the pre-EVD grade, as significantly predictive of long-term outcome (p < 0.04). Conclusion: Long-term outcomes in poor grade patients who improve after EVD placement are similar to patients with lower grade hemorrhages. When an EVD is placed preoperatively in a poor grade aSAH patient, the neurological status after EVD determines the clinical grade.

Original languageEnglish (US)
Pages (from-to)174-180
Number of pages7
JournalNeurocritical Care
Issue number3
StatePublished - Jun 1 2007
Externally publishedYes


  • Acute hydrocephalus
  • Aneurysm
  • External ventricular drainage
  • Poor grade
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine


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