J Cerebrovasc Endovasc Neurosurg.  2014 Jun;16(2):78-84. 10.7461/jcen.2014.16.2.78.

Comparison of Incidence and Risk Factors for Shunt-dependent Hydrocephalus in Aneurysmal Subarachnoid Hemorrhage Patients

• Bae IS
• Yi HJ
• Choi KS
• Chun HJ

• KMID: 1963174
• DOI: http://doi.org/10.7461/jcen.2014.16.2.78

Abstract

OBJECTIVE
The objective of this study was to compare the incidence of ventricular shunt placement for shunt-dependent hydrocephalus (SDHC) after clipping versus coiling of ruptured aneurysms.
MATERIALS AND METHODS
A retrospective review was conducted in 215 patients with aneurysmal subarachnoid hemorrhage (SAH) who underwent surgical clipping or endovascular coiling during the period from May 2008 to December 2011. Relevant clinical and radiographic data were analyzed with regard to the incidence of hydrocephalus and ventriculo-peritoneal shunt (VPS). Patients treated with clipping were assigned to Group A, while those treated with coiling were assigned to Group B.
RESULTS
Of 215 patients (157 clipping, 58 coiling), no significant difference in the incidence of final VPS was observed between treatment modalities (15.3% vs. 10.3%) (p = 0.35). Independent risk factors for VPS for treatment of chronic hydrocephalus were as follows: (1) older than 65 years, (2) poorer Hunt-Hess grade IV and V, (3) Fisher grade III and IV, and (4) particularly initial presence of an intraventricular hemorrhage.
CONCLUSION
In this study comparing two modalities for treatment of aneurysm, there was no difference in the incidence of chronic hydrocephalus requiring VPS. A significantly higher rate of shunt dependency was observed for age older than 65 years, poor initial neurological status, and thick SAH with presence of initial intraventricular hemorrhage. By understanding these factors related to development of SDHC and results, it is expected that management of aneurysmal SAH will result in a better prognosis.

Keyword

Acute hydrocephalus; Chronic hydrocephalus; Subarachnoid hemorrhage; Lumbar drain

MeSH Terms

Aneurysm
Aneurysm, Ruptured
Hemorrhage
Humans
Hydrocephalus*
Incidence*
Prognosis
Retrospective Studies
Risk Factors*
Subarachnoid Hemorrhage*
Surgical Instruments
Ventriculoperitoneal Shunt

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