Chronic Shunt-dependent Hydrocephalus after Early Surgical and Early Endovascular Treatment of Ruptured Intracranial Aneurysms

Gruber, Andreas; Reinprecht, Andrea; Bavinzski, Gerhard; Czech, Thomas; Richling, B.

doi:10.1097/00006123-199903000-00039

Cited by 128 publications

(96 citation statements)

References 28 publications

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“…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) .…”

Section: Discussionsupporting

confidence: 59%

“…Most reports revealed that endovascular coiling could be attributed to an increased rate of SDHC 4,5,19) . However, Gruber et al 8) reported that the endovascular treatment group did not suffer SDHC more frequently than the surgical treatment group.…”

Section: Discussionmentioning

confidence: 98%

“…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. In SAH patients with scanty hemorrhaging, the merit of an open surgical procedure is decreased due to the risk of hydrocephalus.…”

Section: Introductionmentioning

confidence: 98%

“…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%

“…On the other hand, endovascular coiling can lower the incidence of SDHC from minimal brain manipulation and heparinization during and after embolization 2) . According to the report, heparin may reach the CSF space under conditions of blood brain barrier disruption following SAH; however, because heparin may not have lysed previously formed subarachnoid clots, the effect of heparinization on the rate of 2,8,11,14) . According to our data, there was no difference in the incidence of SDHC in FG 1 patients according to treatment modality.…”

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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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