Risk of Shunt-Dependent Hydrocephalus After Occlusion of Ruptured Intracranial Aneurysms by Surgical Clipping or Endovascular Coiling

Oliveira, Jean Gonçalves de; Beck, Jürgen; Setzer, Matthias; Gerlach, Rüdiger; Vatter, Hartmut; Seifert, Volker; Raabe, Andreas

doi:10.1227/01.neu.0000303188.72425.24

Cited by 162 publications

(91 citation statements)

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“…Whether or not incidence of SDHC differs significantly between surgical clipping and endovascular coiling is currently unknown. However, several authors have reported results that demonstrated fewer occurrences of SDHC in the surgical treatment group [3][4][5]19) Another study revealed no difference between the two groups 8) . Early evacuation of cisternal clots during surgery is a possible mechanism for lowering SDHC in the surgical group 8) ; however, this is hypothesized only under thick hemorrhagic conditions.…”

Section: Introductionmentioning

confidence: 97%

“…Suggested risk factors for development of shunt dependent hydrocephalus (SDHC) include location of the aneurysm, Fisher grade (FG) on computed tomography (CT) scan, intraventricular hemorrhage (IVH), and so on 7,13,15,17,20) . Similar to vasospasm, development of hydrocephalus has a strong association with the amount of blood spilled into the subarachnoid space and ventricular system [3][4][5]8) .…”

Section: Introductionmentioning

confidence: 99%

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Risk of Shunt Dependent Hydrocephalus after Treatment of Ruptured Intracranial Aneurysms : Surgical Clipping versus Endovascular Coiling According to Fisher Grading System

Nam

Hamm

Kang

et al. 2010

J Korean Neurosurg Soc

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Objective :The amount of hemorrhage observed on a brain computed tomography scan, or a patient's Fisher grade (FG), is a powerful risk factor for development of shunt dependent hydrocephlaus (SDHC). However, the influence of treatment modality (clipping versus coiling) on the rate of SDHC development has not been thoroughly investigated. Therefore, we compared the risk of SDHC in both treatment groups according to the amount of subarachnoid hemorrhage (SAH). Methods : We retrospectively reviewed 839 patients with aneurysmal SAH for a 5-year-period. Incidence of chronic SDHC was analyzed using each treatment modality according to the FG system. In addition, other well known risk factors for SDHC were also evaluated. Results : According to our data, Hunt-Hess grade, FG, acute hydrocephalus, and intraventricular hemorrhage were significant risk factors for development of chronic SDHC. Coiling group showed lower incidence of SDHC in FG 2 patients, and clipping groups revealed a significantly lower rate in FG 4 patients. Conclusion : Based on our data, treatment modality might have an influence on the incidence of SDHC. In FG 4 patients, the clipping group showed lower incidence of SDHC, and the coiling group showed lower incidence in FG 2 patients. We suggest that these findings could be a considerable factor when deciding on a treatment modality for aneurysmal SAH patients, particularly when the ruptured aneurysm can be occluded by either clipping or coiling.

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Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Risk of Shunt Dependent Hydrocephalus after Treatment of Ruptured Intracranial Aneurysms : Surgical Clipping versus Endovascular Coiling According to Fisher Grading System

Nam

Hamm

Kang

et al. 2010

J Korean Neurosurg Soc

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“…The prevalence of sNPH has been reported to be 8.9%-48% in patients with SAH. [1][2][3][4][5][6][7]11,12,16,18,22,23 Acute hydrocephalus coexisting with SAH is known to be one of the most important predictors for sNPH. [3][4][5][6]11,16 Previous studies have shown that severe symptoms at SAH onset and a large amount of subarachnoid blood seen on admission CT images are associated with the development of sNPH.…”

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confidence: 99%

“…[1][2][3][4][5][6][7]11,12,16,18,22,23 Acute hydrocephalus coexisting with SAH is known to be one of the most important predictors for sNPH. [3][4][5][6]11,16 Previous studies have shown that severe symptoms at SAH onset and a large amount of subarachnoid blood seen on admission CT images are associated with the development of sNPH. [3][4][5][6][7][8][9][10][11]12,16,18,23 A posterior circulation location of the ruptured aneurysm and endovascular coil embolization have been reported to be significantly associated with sNPH.…”

mentioning

confidence: 99%

Aneurysm location and clipping versus coiling for development of secondary normal-pressure hydrocephalus after aneurysmal subarachnoid hemorrhage: Japanese Stroke DataBank

Yamada¹,

Ishikawa²,

Yamamoto³

et al. 2015

JNS

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abbreviatioNs ACA = anterior cerebral artery; ICA = internal carotid artery; MCA = middle cerebral artery; NPH = normal-pressure hydrocephalus; SAH = subarachnoid hemorrhage; sNPH = secondary NPH; WFNS = World Federation of Neurological Societies. submitted December 5, 2014. accepted January 21, 2015. iNclude wheN citiNg Published online July 31, 2015; DOI: 10.3171/2015.1.JNS142761. disclosure Dr. Ishikawa has received honoraria from Medtronic Japan Co., Ltd. (Japan). Dr. Yamada declares no disclosures and no conflicts of interest. Drs. Yamamoto, Ino, Kimura, and Kobayashi report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. All authors have made substantial contributions to the intellectual content of the paper, have approved the final manuscript, and agree with submission to this journal. Dr. Yamada is the corresponding author for this study and the principal investigator. He takes responsibility for data management, accuracy of statistical analysis, conduct of the research, and drafting of the manuscript. The following grants funded this study: " obJect The present study aimed to investigate aneurysm locations and treatments for ruptured cerebral aneurysms associated with secondary normal-pressure hydrocephalus (sNPH) after subarachnoid hemorrhage (SAH) by using comprehensive data from the Japanese Stroke DataBank. methods Among 101,165 patients with acute stroke registered between 2000 and 2013, 4693 patients (1482 men, 3211 women) were registered as having had an SAH caused by a ruptured saccular aneurysm. Of them, 1448 patients (438 men and 1010 women; mean age 61.9 ± 13.4 years) who were confirmed to have or not have coexisting acute hydrocephalus and sNPH were included for statistical analyses. Locations of the ruptured aneurysms were subcategorized into 1 of the following 4 groups: middle cerebral artery (MCA; n = 354), anterior communicating artery and anterior cerebral artery (ACA; n = 496), internal carotid artery (ICA; n = 402), and posterior circulation (n = 130). Locations of 66 of the ruptured aneurysms were unknown/unrecorded. Treatments included craniotomy and clipping alone in 1073 patients, endovascular coil embolization alone in 285 patients, and a combination of coiling and clipping in 17 patients. The age-adjusted and multivariate odds ratios from logistic regression analyses were calculated after stratification using the Fisher CT scale to investigate the effects of the hematoma volume of SAH. results Acute hydrocephalus was confirmed in 593 patients, and 521 patients developed sNPH. Patients with a ruptured ACA aneurysm had twice the risk for sNPH over those with a ruptured MCA aneurysm. Those with an ACA aneurysm with Fisher Grade 3 SAH had a 9-fold-higher risk for sNPH than those with an MCA aneurysm with Fisher Grade 1 or 2 SAH. Patients with a ruptured posterior circulation aneurysm did not have any significant risk for sNPH. Clipping of the ruptured aneurysm resulted in twice the risk for sNPH over coil emboli...

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“…After aneurysmal SAH, ventriculoperitoneal shunt dependence due to hydrocephalus is a frequent observation with an incidence up to almost 20% (de Oliveira et al, 2007). Most patients require shunt treatment for malabsorbtive hydrocephalus, although some patients with aneurysms suffer from hydrocephalus due to CSF pathway obstruction rather than malresorption.…”

Section: Surgical Treatmentmentioning

confidence: 99%

Intraventricular Cerebrovascular Pathologies of Hydrocephalus and Managements

Şanlı¹,

Kertmen²,

Gürer³

2012

Hydrocephalus

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Risk of Shunt-Dependent Hydrocephalus After Occlusion of Ruptured Intracranial Aneurysms by Surgical Clipping or Endovascular Coiling

Abstract: Clipping of a ruptured aneurysm may be associated with a lower risk for developing shunt dependency, possibly by clot removal. This might influence long-term outcome and surgical decision making.

Cited by 162 publications

References 44 publications

Risk of Shunt Dependent Hydrocephalus after Treatment of Ruptured Intracranial Aneurysms : Surgical Clipping versus Endovascular Coiling According to Fisher Grading System

Risk of Shunt Dependent Hydrocephalus after Treatment of Ruptured Intracranial Aneurysms : Surgical Clipping versus Endovascular Coiling According to Fisher Grading System

Aneurysm location and clipping versus coiling for development of secondary normal-pressure hydrocephalus after aneurysmal subarachnoid hemorrhage: Japanese Stroke DataBank

Intraventricular Cerebrovascular Pathologies of Hydrocephalus and Managements

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