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KMID : 1001920080430040177
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Journal of Korean Neurosurgical Society
2008 Volume.43 No. 4 p.177 ~ p.181
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Predisposing Factors Related to Shunt-Dependent Chronic Hydrocephalus after Aneurysmal Subarachnoid Hemorrhage
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Kwon Jae-Hyun
Sung Soon-Ki
Kim Hyung-Dong
Huh Jae-Taeck
Song Yong-Jin
Choi Hyu-Jin
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Abstract
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Objectives: 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 (?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.
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KEYWORD
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Subarachnoid hemorrhage, Ventriculoperitoneal shunt, Chronic hydrocephalus, Related factor
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