Predisposing Factors Related to Shunt-Dependent Chronic Hydrocephalus after Aneurysmal Subarachnoid Hemorrhage.
10.3340/jkns.2008.43.4.177
- Author:
Jae Hyun KWON
1
;
Soon Ki SUNG
;
Young Jin SONG
;
Hyu Jin CHOI
;
Jae Taeck HUH
;
Hyung Dong KIM
Author Information
1. Department of Neurosurgery, College of Medicine, Dong-A University, Busan, Korea. mirajoo77@naver.com
- Publication Type:Original Article
- Keywords:
Subarachnoid hemorrhage;
Ventriculoperitoneal shunt;
Chronic hydrocephalus;
Related factor
- MeSH:
Aneurysm;
Aneurysm, Ruptured;
Animals;
Cerebral Hemorrhage;
Hemorrhage;
Horns;
Humans;
Hydrocephalus;
Meningitis;
Prognosis;
Retrospective Studies;
Subarachnoid Hemorrhage;
Ventriculoperitoneal Shunt
- From:Journal of Korean Neurosurgical Society
2008;43(4):177-181
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: Hydrocephalus is a common sequelae of aneurysmal subarachnoid hemorrhage (SAH) and patients who develop hydrocephalus after SAH typically have a worse prognosis than those who do not. This study was designed to identify factors predictive of shunt-dependent chronic hydrocephalus among patients with aneurysmal SAH, and patients who require permanent cerebrospinal fluid diversion. METHODS: Seven-hundred-and-thirty-four patients with aneurysmal SAH who were treated surgically between 1990 and 2006 were retrospectively studied. Three stages of hydrocephalus have been categorized in this paper, i.e., acute (0-3 days after SAH), subacute (4-13 days after SAH), chronic (> or =14 days after SAH). Criteria indicating the occurrence of hydrocephalus were the presence of significantly enlarged temporal horns or ratio of frontal horn to maximal biparietal diameter more than 30% in computerized tomography. RESULTS: Overall, 66 of the 734 patients (8.9%) underwent shunting procedures for the treatment of chronic hydrocephalus. Statistically significant associations among the following factors and shunt-dependent chronic hydrocephalus were observed. (1) Increased age (p < 0.05), (2) poor Hunt and Hess grade at admission (p < 0.05), (3) intraventricular hemorrhage (p < 0.05), (4) Fisher grade III, IV at admission (p < 0.05), (5) radiological hydrocephalus at admission (p < 0.05), and (6) post surgery meningitis (p < 0.05) did affect development of chronic hydrocephalus. However the presence of intracerebral hemorrhage, multiple aneurysms, vasospasm, and gender did not influence on the development of shunt-dependent chronic hydrocephalus. In addition, the location of the ruptured aneurysms in posterior cerebral circulation did not correlate with the development of shunt-dependent chronic hydrocephalus. CONCLUSION: Hydrocephalus after aneurysmal SAH seems to have a multifactorial etiology. Understanding predisposing factors related to the shunt-dependent chronic hydrocephalus may help to guide neurosurgeons for better treatment outcomes.
