J Cerebrovasc Endovasc Neurosurg.  2018 Jun;20(2):87-95. 10.7461/jcen.2018.20.2.87.

Does Neurosurgical Clipping or Endovascular Coiling Lead to More Cases of Delayed Hydrocephalus in Patients with Subarachnoid Hemorrhage?

• Eom TO
• Park ES
• Park JB
• Kwon SC
• Sim HB
• Lyo IU
• Kim MS

• KMID: 2422602
• DOI: http://doi.org/10.7461/jcen.2018.20.2.87

Abstract

OBJECTIVE
We investigated whether clipping or endovascular treatment (EVT) can reduce the incidence of delayed hydrocephalus. We also investigated whether additional procedures, namely lumbar drainage and extra-ventricular drainage (EVD), decrease the incidence of delayed hydrocephalus in patients with subarachnoid hemorrhage (SAH).
MATERIALS AND METHODS
One-hundred and fifty-two patients who had undergone an operation for SAH were enrolled in this study. Clinical data, radiological data, and procedural data were investigated. Procedural data included the operating technique (clipping vs. EVT) and the use of additional procedures (no procedure, lumbar drainage, or EVD). Delayed hydrocephalus was defined as a condition in which the Evan's index was 0.3 or higher, as assessed using brain computed tomography more than 2 weeks after surgery, requiring shunt placement due to neurological deterioration.
RESULTS
Of the 152 patients, 45 (29.6%) underwent surgical clipping and 107 (70.4%) underwent EVT. Twenty-five (16.4%) patients developed delayed hydrocephalus. Age (p = 0.019), procedure duration (p = 0.004), and acute hydrocephalus (p = 0.030) were significantly correlated with the incidence of delayed hydrocephalus. However, the operation technique (p = 0.593) and use of an additional procedure (p = 0.378) were not significantly correlated with delayed hydrocephalus incidence.
CONCLUSION
No significant difference in the incidence of delayed hydrocephalus was associated with operation technique or use of an additional procedure in patients with SAH. However, delayed hydrocephalus was significantly correlated with old age, long procedural duration, and acute hydrocephalus. Therefore, we recommend that additional procedures should be discontinued as soon as possible.

Keyword

Hydrocephalus; Subarachnoid hemorrhage; Aneurysm; Cerebrospinal fluid

MeSH Terms

Aneurysm
Brain
Cerebrospinal Fluid
Drainage
Humans
Hydrocephalus*
Incidence
Subarachnoid Hemorrhage*
Surgical Instruments

Figure

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  Fig. 1 The Evans index is the most common measurement used to establish ventricular dilation in the diagnosis of hydrocephalus. It is calculated by dividing the width of the frontal horns of the lateral ventricles by the maximum biparietal diameter (Evans index = D1/D2). D1 = the width of the frontal horns of the lateral ventricles; D2 = the maximum biparietal diameter.

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