The relationship of subarachnoid hemorrhage and the need for postoperative shunting

Abstract

The incidence of chronic hydrocephalus requiring shunting after aneurysmal subarachnoid hemorrhage (SAH) is not precisely known. The authors investigated whether the need for ventriculoperitoneal (VP) shunting can be predicted by initial Hunt and Hess grade or Fisher computerized tomography score. One hundred eight patients who presented with SAH and underwent 116 surgical procedures for aneurysm clipping were evaluated retrospectively to determine the incidence of chronic hydrocephalus. Chronic hydrocephalus was defined as clinically and radiographically demonstrated hydrocephalus that lasted 2 weeks or longer after the original hemorrhage and that required shunting. All SAH patients were managed in a similar fashion with induced hypervolemia, relative hemodilution, and hypertension complemented by a course of calcium channel blockers. The majority of patients underwent perioperative extracranial ventricular drainage to allow intraoperative brain relaxation and to assist intracranial pressure management. The overall mortality rate of the study group was 17%. Of the surviving patients, 20% underwent VP shunt placement secondary to chronic hydrocephalus. There were no statistically significant relationships between chronic hydrocephalus and patient age or gender, aneurysm type and size, or use of a perioperative drain. There was a high clinical correlation between chronic hydrocephalus and admission Hunt and Hess grades and Fisher grades (p < 0.05). All of the patients who survived a second bleeding episode and almost 46% of the patients who presented with intraventricular hemorrhage required placement of a VP shunt. The authors present predictive tables of chronic hydrocephalus based on the patient's admission Hunt and Hess grade and Fisher classification.

HydroCoil Endovascular Aneurysm Occlusion and Packing Study (HELPS Trial): Procedural Safety and Operator-Assessed Efficacy Results

“…However, data on hydrocephalus were recorded. For ruptured aneurysms in HELPS, periprocedural (randomization to 3 months) hydrocephalus rates of 15.2%-18.7% are comparable with those reported in the literature: 6%-63%, 23 though more commonly in the range of 15%-20%. 24 No difference between the hydrogel coil and control arms has been identified in HELPS, in either recently ruptured or unruptured aneurysms (Table 5), with cases of hydrocephalus occurring in unruptured aneurysms in both arms.…”

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

“…Dorai et al 5) stated that 1.3% of shunt-treated patients were in FG 1, whereas 86% of patients were reported as FG 3. Also, the influence of the quantity of blood in the subarachnoid space was supported by results from many other studies 7,8,12,18) . Our results showed a total rate of SDHC of 19.7%, which was consistent with results from other series found in the literature 4,5,8,16) .…”

Expression of HGF and VEGF in the cerebral tissue of adult rats with chronic hydrocephalus after subarachnoid hemorrhage

“…There is a high clinical correlation found between chronic hydrocephalus and the female gender, distal posterior circulation location of the ruptured aneurysm, increasing age, more extensive bleeding, and Hunt and Hess and Fisher grades at the time of hospital admission (23)(24)(25). Almost 46% of the patients who presented with intraventricular hemorrhage required placement of a ventriculoperitoneal (VP) shunt (25).…”