OBJECTIVE: This study aimed to evaluate the clinical course of subdural fluid (SDF) collection following surgery for a ruptured aneurysm and to set up a management plan for it. METHODS: Of 288 patients who underwent open aneurysm surgery for a ruptured aneurysm, 97 patients (33.7%) had impaired cerebrospinal fluid circulation in the form of subdural fluid collection or hydrocephalus during the postoperative period. We categorized these patients into 3 groups. Group A comprised patients who experienced spontaneously resolved postoperative SDF collection. Group B comprised patients who experienced a postoperative SDF collection that evolved into internal hydrocephalus. Group C comprised patients who experienced hydrocephalus without subdural fluid collection during the postoperative period. We retrospectively reviewed radiographic images and clinical data to determine the differences between the three groups with respect to age, initial clinical grade, and Fisher grade. RESULTS: Group B and group C had similar proportions of patients over 60 years of age in comparison to group A. Compared to group A, group B had a greater proportion of patients whose initial Hunt and Hess grades (HHG) were III, IV, or V (p = 0.040), and group B had a larger proportion of patients whose initial Fisher grades (FG) were III or IV (p = 0.020). CONCLUSION: Based on our understanding of SDF collection's clinical course and mechanism, we carefully suggest that clinicians consider the presence of cortical atrophy, the initial CT grade, and the clinical grades when establishing a treatment plan for SDF collection.
Aneurysm ; Aneurysm, Ruptured ; Atrophy ; Craniotomy ; Humans ; Hydrocephalus ; Postoperative Period ; Retrospective Studies ; Subarachnoid Hemorrhage ; Subdural Effusion

A hemodialysis arteriovenous fistula may cause high output cardiac state by volume overload and decreased systemic vascular resistance. Arteriovenous fistulas for hemodialysis consist usually of either a radiocephalic fistula at the wrist or a more proximal brachiocephalic fistula at the antecubital fossa. In this study the contribution of arteriovenous fistula to cardiac function has been evaluated by comparing cardiac performance before and after the point occlusion of the anastomotic site. The results suggest that the occlusion of arteriovenous fistula may decrease end-diastolic left ventricular volume (VOLd), increase end-systolic left ventricular volume (VOLs), decrease stroke volume (SV), decrease ejection fraction (EF) and decrease cardiac output (CO). This study shows that arteriovenous fistula influences directly to cardiac performance, so careful determination of dialysis option is required for the end stage renal failure patients with marginal heart function.
Arteriovenous Fistula ; Cardiac Output ; Dialysis ; Fistula ; Heart ; Humans ; Renal Dialysis ; Renal Insufficiency ; Stroke Volume ; Vascular Resistance ; Wrist