Frequency and Timing of Programmable Shunt Valve Adjustments After Aneurysmal Subarachnoid Hemorrhage

OBJECTIVE: Hydrocephalus requiring ventriculoperitoneal shunt (VPS) placement in patients with aneurysmal subarachnoid hemorrhage (aSAH). Programmable shunt valves may reduce the need for surgical revision by allowing noninvasive correction of over- or underdrainage. However, data describing the frequency and timing of postoperative valve adjustments in this population remain limited. We sought to characterize the incidence, direction, and temporal pattern of programmable valve setting changes following VPS placement after aSAH. METHODS: We performed a single-institution retrospective analysis of patients who underwent programmable VPS placement (Medtronic Strata II or Codman Certas Plus) for hydrocephalus following treatment of ruptured intracranial aneurysms between 2017 and 2022. RESULTS: Among 398 patients treated for aSAH, 49 (12%) required VPS placement for hydrocephalus. Aneurysms were treated endovascularly in 41 patients (84%) and surgically in 8 (16%). Forty-two patients received Medtronic Strata II valves (median initial setting: 1.0) and seven received Codman Certas Plus valves (median initial setting: 4). Valve adjustment was required in 18 patients (37%): 10 for underdrainage, 6 for overdrainage, and two requiring multiple adjustments. Most adjustments occurred during the index hospitalization, with 15 (83%) performed within 7 days of VPS placement. CONCLUSION: Valve setting adjustments were common following programmable VPS placement for post-aSAH hydrocephalus, occurring in more than one-third of patients. Underdrainage was the most frequent indication for adjustment, and the majority of changes occurred within the first postoperative week. These findings highlight the importance of early clinical and radiographic surveillance and support the utility of programmable valves in hydrocephalus after aSAH.