Predictors of hydrocephalus as a complication of non-traumatic subarachnoid hemorrhage: a retrospective observational cohort study in 107 patients

Abstract

BackgroundThe predictors of shunt dependency such as amount of subarachnoid blood, acute hydrocephalus (HC), mode of aneurysm repair, clinical grade at admission and cerebro spinal fluid (CSF) drainage in excess of 1500 ml during the 1st week after the subarachnoid hemorrhage (SAH) have been identified as predictors of shunt dependency. Therefore our main objective is to identify predictors of CSF shunt dependency following non-traumatic subarachnoid hemorrhage.MethodsWe performed a retrospective study including patients from January 1st 2012 to September 30th 2014 between 16 and 89 years old and had a non-traumatic subarachnoid hemorrhage in cranial computed tomography (CCT). We excluded patients with the following characteristics: Patients who died 3 days after admittance, lesions in brainstem, previous surgical treatment in another clinic, traumatic brain injury, pregnancy and disability prior to SAH.We performed a descriptive and comparative analysis as well as a logistic regression with the variables that showed a significant difference (p < 0.05). Hence we identified the variables concerning HC after non traumatic SAH and its correlation.ResultsOne hundred and seven clinical files of patients with non-traumatic SAH were analyzed. Twenty one (48%) later underwent shunt treatment. Shunt patients had significantly clinical and corroborated with doppler ultrasonography vasospasmus (p = 0.015), OR = 5.2. The amount of subarachnoidal blood according to modified Fisher grade was (p = 0.008) OR = 10.9. Endovascularly treated patients were less often shunted as compared with those undergoing surgical aneurysm repair (p = 0.004).ConclusionVasospasmus and a large amount of ventricular blood seem to be a predictor concerning hydrocephalus after non-traumatic SAH. Hence according to our results the presence of these two variables could alert the treating physician in the decision whether an early shunt implantation < 7 days after SAH should be necessary.

Optimal Timing and Complications of Cranioplasty: A Single-Center Retrospective Review of 109 Cases

“…As such, it appears that the cause of craniectomy, which is the initial condition of the patient's disease, had a stronger relationship than the operation timing. This finding is in line with the studies explaining the mechanism of hydrocephalus (by the mass effect of blood clots and the obstruction by inflammation-mediated adhesions of the ventricle) 4,5,23) . Additionally, there was a statistically significant association between the prevalence of hydrocephalus and the number of revision surgeries performed between the decompressive craniectomy and the cranioplasty (p = 0.046).…”

“…The DECRA and RESCUEICP's randomized controlled trials 3,19) and the DECIMAL, DESTINY, and HAMLET randomized controlled trials showed that decompressive craniectomy significantly treated intracranial hypertension and was associated with an increase in survival rates in traumatic brain injury and spontaneous ischemic or hemorrhagic stroke 23,24,25) . www.e-jnic.org…”

Hydrocephalus after aneurysmal subarachnoid hemorrhage: Epidemiology, Pathogenesis, Diagnosis, and Management

“…However, this is not a strict incidence estimate, as the entire population has not been screened. Acute and chronic hydrocephalus occurs in about 20% and 10% of patients with aSAH, respectively [2,3,28]. Acute hydrocephalus occurs within 3 days after the bleeding, subacute within 14 days, and chronic hydrocephalus occurs after 14 days [29].…”

“…However, Savarra et al suggested that there is no significant difference between EVD and SDHC [39]. Besides, many studies have analyzed a large number of clinical data and concluded that vasospasm [3,14,38], cerebral infarction [15], and meningitis [47] are closely associated with SDHC after aSAH.…”

“…Subarachnoid hemorrhage (SAH) is a severe form of cerebrovascular disease, with a mortality rate of 40-60% and an incidence of 8-20/10,000 [1][2][3]. It is mainly consecutive to aneurysm rupture.…”