[Hydrocephalus following subarachnoid hemorrhage]

Area of Science:

• Neurosurgery
• Neurology
• Critical Care Medicine

Background:

• Post-hemorrhagic hydrocephalus (PHH) is a significant complication following subarachnoid hemorrhage (SAH).
• Ruptured intracranial aneurysms are a primary cause of SAH and subsequent PHH.
• Understanding the incidence and risk factors for PHH is crucial for patient management.

Purpose of the Study:

• To investigate the incidence and characteristics of post-hemorrhagic hydrocephalus in patients with ruptured intracranial aneurysms.
• To evaluate the effectiveness and risks associated with external ventricular drainage (EVD) in managing PHH.
• To determine optimal timing and patient selection for EVD in the context of SAH.

Main Methods:

• Retrospective analysis of 410 patients with PHH, including 320 with ruptured intracranial aneurysms.
• Comparison of ventricular dilatation rates based on aneurysm status and clinical grading.
• Assessment of outcomes for 51 patients treated with external ventricular drainage (EVD).

Main Results:

• Ventricular dilatation occurred more frequently in patients with aneurysmal SAH (44%) compared to those without detected vascular malformations (21%).
• Hydrocephalus was significantly more common in higher clinical grades of SAH.
• EVD led to significant improvement in 54% of patients, but half experienced fatal re-hemorrhage during drainage.

Conclusions:

• EVD may be indicated for Grade IV and occasionally Grade III patients with PHH, provided early radical surgery is performed promptly after initial improvement.
• This approach aims to prevent fatal re-hemorrhages during EVD.
• Chronic cerebrospinal fluid dynamic disturbances requiring permanent shunting were rare in this cohort.