Independent Predictors of Late Hydrocephalus in Patients with Aneurysmal Subarachnoid Hemorrhage – Analysis by Multivariate Logistic Regression Model

Hirashima, Yutaka; Hamada, Hideo; Hayashi, Nakamasa; Kuwayama, Naoya; Origasa, Hideki; Endo, Shunro

doi:10.1159/000071117

Cited by 51 publications

(38 citation statements)

References 14 publications

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“…The mortality rate has been reported to be as high as 42.6–83.3% [16], the mortality rate of surgery 35.7–100% [17]. When the IVH is large enough to impede normal cerebrospinal fluid circulation, acute obstructive hydrocephalus can occur in the subacute and chronic stages of IVH, communicating hydrocephalus may develop if fibrosis of the basal leptomeninges occurs or reabsorption of CSF becomes impaired from fibrosis of the arachnoid villus [18,19,20,21,22]. Although there have been some medical or surgical therapies for IVH, none of them are encouraged.…”

Section: Discussionmentioning

confidence: 99%

Application of Neuroendoscopy in the Treatment of Intraventricular Hemorrhage

Zhang¹,

Li²,

Liu³

et al. 2007

Cerebrovasc Dis

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Background: Spontaneous intraventricular hemorrhage is an infrequent but severe complication of hemorrhagic stroke. The conventional treatment of intraventricular hemorrhage consists of ventricular drainage or surgical evacuation, but neither of them is encouraged. The objective of this article is to compare different surgical procedures in order to evaluate a method of minimally invasive treatment for intraventricular hemorrhage. Methods: Neuroendoscopy was applied to treat 22 cases of intraventricular hemorrhage. Twenty cases of the same disease that were treated by external ventricular drainage were taken as a control and comparison. Results: All patients were followed up for 2 months. In the neuroendoscopy group, according to the Glasgow outcome scale, the result was excellent in 5 cases, good in 9, fair in 4, poor in 2 and death in 2. In the external ventricular drainage group, the result was excellent in 1 case, good in 5, fair in 7, poor in 5 and death in 2. More patients in the neuroendoscopy group showed good recovery after 2 months of surgery (p < 0.05). The difference in mortality rate between the 2 groups was not statistically significant (p > 0.05). Conclusions: Neuroendoscopic neurosurgery for intraventricular hemorrhage offers better surgical treatment because it is characterized by visualized manipulation, effective hemorrhage evacuation and excellent postoperative outcomes.

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Section: Discussionmentioning

confidence: 99%

Application of Neuroendoscopy in the Treatment of Intraventricular Hemorrhage

Zhang¹,

Li²,

Liu³

et al. 2007

Cerebrovasc Dis

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“…Chronic hydrocephalus after aneurysmal SAH that impairs cerebrospinal fluid (CSF) dynamics and therefore requires a permanent CSF diversion is called ‘shunt-dependent chronic hydrocephalus'. Several previous studies have identified multiple factors, such as increased age, female sex, poor Hunt and Hess (H&H) grade, acute hydrocephalus, distal posterior circulation aneurysms, cerebral vasospasm, antifibrinolytic therapy, and intraventricular haemorrhage (IVH), that could predict the need for permanent CSF diversion [1,4,6,7,8,9]. However, the link between fever and shunt-dependent hydrocephalus remains poorly understood [10].…”

Section: Introductionmentioning

confidence: 99%

Predictors of Shunt-Dependent Chronic Hydrocephalus after Aneurysmal Subarachnoid Haemorrhage

Yang

Chang²,

Liu³

et al. 2013

Eur Neurol

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Introduction: Chronic hydrocephalus is a common complication that can occur after aneurysmal subarachnoid haemorrhage (SAH). The purpose of this study was to investigate clinical risk factors that could predict the occurrence of shunt-dependent chronic hydrocephalus after aneurysmal SAH. Methods: Eighty-eight consecutive patients who underwent either surgery or transarterial endovascular embolization as a treatment for cerebral aneurysm within 72 h -after experiencing SAH from March 2005 to July 2006 were studied retrospectively to assess the risk factors that might predict shunt-dependent chronic hydrocephalus. Clinical and demographic factors were examined, including age, sex, initial admission mean arterial blood pressure (MABP), blood sugar level at admission, fever frequency, initial external ventricular drainage (EVD), Fisher grade, Hunt and Hess grade, intraventricular haemorrhage (IVH) and treatment methods to define predictors of shunt-dependent hydrocephalus. The length of hospital stay and modified Rankin scale recorded 6 months after SAH were also evaluated; these parameters were compared between the shunt-dependent and non-shunt-dependent groups. Results: Of the 88 patients, 22 (25%) underwent shunt placement to treat their chronic hydrocephalus. The average length of hospital stay was 33.9 days for the shunt-treated group and 14 days for the non-shunt-treated group. The non-shunt-treated group scored an average of 1.05 on the modified Rankin scale compared with 2.77 for the shunt-treated group. A univariate analysis revealed that several admission variables were associated with long-term shunt-dependent hydrocephalus: (1) increased age (p = 0.023); (2) initial admission MABP (p = 0.027); (3) a high Fisher grade (p = 0.031); (4) a poor admission Hunt and Hess grade (p = 0.030); (5) the presence of IVH (p = 0.029), and (6) initial EVD (p < 0.0001). The factor most commonly associated with shunt-dependent hydrocephalus over the course of hospital days was fever frequency (p < 0.0001). Conclusions: Chronic hydrocephalus after aneurysmal SAH has a multifactorial aetiology. Understanding the risk factors that predict the occurrence of chronic hydrocephalus may help neurosurgeons to expedite permanent cerebrospinal fluid diversion, which could decrease both the cost and length of hospital stay and prevent further complications.

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“…Measurement of sequential changes of oxyhemoglobin concentration showed decreases by day 5 and maintenance at a very low level with urokinase irrigation, but increases peaking on day 9 without urokinase irrigation. 13) Our previous report 9) and others 1,12,15) have indicated that duration of CSF drainage is a statistically significant predictor of late hydrocephalus after SAH. Continuous CSF drainage may promote occlusion of physiological CSF pathways.…”

Section: Discussionmentioning

confidence: 90%

“…Therefore, intermittent CSF drainage has been suggested to keep the normal subarachnoid space open, because intermittent CSF pressure is an effective force in preventing the formation of occlusive membranes and clots. 11) Our previous study 9) showed that brain damage due to intraoperative manipulation and cerebral vasospasm is involved in the pathogenesis of late hydrocephalus. Excessive drainage of CSF is related to a greater incidence of cerebral infarction and occurrence of late hydrocephalus.…”

Section: Discussionmentioning

confidence: 99%

“…3,16) However, increased incidence of cerebral infarction and late shunt-dependent hydrocephalus have been observed following excessive drainage of CSF. 1,9,12,15) Meningitis and intracranial hemorrhage are also possible complications of CSF drainage. 17) No data is available about the duration of CSF drainage necessary after acute surgery to prevent the occurrence of vasospasm and late hydrocephalus.…”

Section: Introductionmentioning

confidence: 99%

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Duration of Cerebrospinal Fluid Drainage in Patients With Aneurysmal Subarachnoid Hemorrhage for Prevention of Symptomatic Vasospasm and Late Hydrocephalus

Hirashima

Kurimoto

Hayashi

et al. 2005

Neurol. Med. Chir.(Tokyo)

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The optimal duration of cerebrospinal fluid (CSF) drainage after acute aneurysm surgery is unclear. The association between the occurrence of symptomatic vasospasm or late hydrocephalus and the duration of CSF drainage was investigated using multiple logistic analysis in 95 consecutive patients with aneurysmal subarachnoid hemorrhage who underwent surgery within 72 hours after onset. The duration of drainage was significantly related to the occurrence of symptomatic vasospasm and late hydrocephalus. The cut-off values of the duration of drainage for preventing symptomatic vasospasm and late hydrocephalus were 11 days (adjusted odds ratio 0.347, 95% confidence interval 0.135-0.889, p ＝ 0.0274) and 6 days (adjusted odds ratio 4.86, 95% confidence interval 1.46-16.2, p ＝ 0.0099), respectively. Prevention of both symptomatic vasospasm and late hydrocephalus is not possible without additional procedures such as cisternal irrigation using fibrinolytic agents.

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Independent Predictors of Late Hydrocephalus in Patients with Aneurysmal Subarachnoid Hemorrhage – Analysis by Multivariate Logistic Regression Model

Cited by 51 publications

References 14 publications

Application of Neuroendoscopy in the Treatment of Intraventricular Hemorrhage

Application of Neuroendoscopy in the Treatment of Intraventricular Hemorrhage

Predictors of Shunt-Dependent Chronic Hydrocephalus after Aneurysmal Subarachnoid Haemorrhage

Duration of Cerebrospinal Fluid Drainage in Patients With Aneurysmal Subarachnoid Hemorrhage for Prevention of Symptomatic Vasospasm and Late Hydrocephalus

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