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KMID : 1005420100120030147
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Journal of Cerebrovascular and Endovascular Neurosurgery
2010 Volume.12 No. 3 p.147 ~ p.155
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Management of Subdural Fluid Collection Following Surgery for Ruptured Aneurysm
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Bahn Yoo-Chang
Chung Joon-Ho
Chung Jong-Kwon
Hyun Dong-Keun
Park Hyeon-Seon
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Abstract
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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.
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KEYWORD
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subarachnoid hemorrhage, craniotomy, subdural hygroma, hydrocephalus, disturbed CSF circulation, compromised
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