Effects And Risk Factors Of Chronic Hydrocephalus After Neurosurgical And Endovascular Treatment Of Ruptured Intracranial Aneurysms

Objective:1.To compare the effects of neurosurgical and endovasculartreatment on the development of chronic hydrocephalus in patients withruptured intracranial aneurysms.2. To study the factors of hydrocephalus inthe patients with aneurysmal subarachnoid hemorrhage.Materials and Methods: We retrospectively reviewed the medicalrecords of all patients admitted with aneurysmal SAH in our university tertiary1stand2ndhospital during3years between January1st2009and December20th2011. This retrospective analysis covered patients fufilling the followingcriteria:①The diagnosis of SAH was made by CT of head or lumbarpuncture.②The diagnosis of a cerebral aneurysm was made either by DSA,MRA or CTA.③The treatment neurosurgical clipping or endovascularcoiling was performed. Exclusion criteria included:①patients withsubarachnoid hemorrhage (SAH) but no aneurysm was found.②aneurysmalpatients complicating with trauma, tumor, blood diseases, arteriovenousmalformation or MoyaMoya disease.③hydrocephalus presented beforeSAH.④no CT scans both within72hours and after3weeks of SAH.⑤death within3weeks or loss conection⑥conservatively treated patients.⑦aneurysms treated both endovascularly and neurosurgically. We reviewed themedical records of all patients admitted with aneurysmal SAH and collectedessential information such as gender, age, hypertension, diabetes, smokingor alcohol consumption history, Hunt-Hess grade, GCS scores, aneurysmlocation, number and size, operating time, treatment and length of stay. Byfollowing up the discharging patients and reviewing the radiological records,collected cranial CT scans both within72hours and after3weeks of SAH.Assessed the Fisher grade and hydrocephalus diagnosis. The diagnosis criteria of hydrocephalus includes:①the width of lateral ventricle frontal horn ismore than45mm;②the width of inner margin of bilateral caudate nucleus>25mm;③the width of the third ventricle>6mm;④the width of the fourthventricle>20mm. However, primary brain atrophy should be excluded andclinical presentation of patients should be considered. Hydrocephalus includesacute (<3days)and chronic hydrocephalus(>21days). Firstly divided thepatients into clipping and coiling groups, then statistical analysis of the datawas performed to assess any differences in the incidence of chronichydrocephalus between the two groups. Secondly divided all patients intoCH(chronic hydrocephalus) and no CH groups, performed the univariateanalysis from which variables with p values less than0.05were entered instepwise logistic regressions. Finally the factors of chronic hydrocephalus inthe patients with aneurysmal subarachnoid hemorrhage were found.Results: In626aneurysmal SAH patients,240were excluded and threehundred and eighty-six patients were brought into research. Coiling wereperformed on253and clipping on133patients. Age of the386patients in thestudy ranged from20years to84years and mean age was53.3years±10.39(SD) with67.4%being women. No difference was found in age, gender, pasthistory, Hunt-Hess grade, Fisher grade, acute hydrocephalus, rebleeding,admission GCS scores between clipping and coiling groups. Anteriorcirculation aneurysms occupied the main location part in both the two groups.Posterior communicating artery aneurysm was most common, then Anteriorcommunicating artery aneurysm and middle artery aneurysm. Most of theaneurysms are middle size(5~10mm). The two groups had no difference in thenumber or side of aneurysms. Most of the posterior circulation aneurysms(91.6%) were coiled endovascularly while more large aneurysms(>10mm)were clipped neurosurgically. More patients in coiling group got earlytreatment than clipping group(P=0.001). Patients with intraventricularhemorrhage in clipping group(34.98%) were more than coiling group(10.45%,P=0.001). The length of stay between clipping group(14.92±6.31days) andcoiling group(13.56±8.62days) was statistically different(P=0.001). After clipping25.7%and after coiling29.3%of the patients developed chronichydrocephalus. There was no statistically significant differences in theincidence of chronic hydrocephalus between the treatment groups(p=0.445).Finally104patients(26.9%) performed chronic hydrocephalus. In a logisticregression model, chronic hydrocephalus was independently associated withacute hydrocephalus, rebleeding, Fisher grade and admission GCS.Conclusion: The treatment method neurosurgical clipping orendovascular coiling used for ruptured intracranial aneurysms, has nostatistically significant effect on the development of chronic hydrocephalus. Inour study chronic hydrocephalus after aSAH seems to have multiple riskfactors including acute hydrocephalus, rebleeding, Fisher grade and lowadmission GCS. However the treatment method used is not a predisposingfactor.