뇌동맥류 수술 환자에서 급성 수두증 병발후 단락술이 요하는 만성 수두증 합병의 임상적 및 형태학적 비교

The Clinical and Radiological Analysis of Shunt-Dependent Hydrocephalus after Acute Hydrocephalus in Surgical Aneurysmal Patients

Objectives : The incidence of acute hydrocephalus(AHC) after aneurysmal subarachnoid hemorrhage reported as 13-31%. The AHC resolves spontaneously in some cases(simple AHC), but about 30% of the AHC progresses to shunt-dependent hydrocephalus(SDHC). The aim of this study was to understand clinical predisposing factors causing SDHC with performing differential clinical analyses between 2 subgroups, the simple AHC and the progresed SDHC. Methods : The 250 surgically treated patients with aneurysmal SAH over last two years were evaluated. Forty four patients(17.6%) of them showed the AHC. Of theses 37 cases were retrospectively analyzed, excluding 7 patients who died within 2 weeks after hemorrhage attack. Of the 37 AHC cases, 21 patient(56.8%) were complicated with the simple AHC, and 16 cases(43.2%) were progressed SDHC. Results : The older age(p<0.05), poor clinical grade(p＝0.03), larger amount of SAH in perimesencephalic cistern on CT scan(p＝0.005) were significantly related to the SDHC. No significant difference was noted in aneurysm location, multiplicity, rebleeding, hypertension and Fisher grade between 2 subgroups. Conclusion : Of the total 37 AHC, the simple AHC was 56.8% and the progressed SDHC 43.2%. The older age, poor clinical grade, large amount of SAH in perimesencephalic cistern were significant predisposing factors causing the SDHC. The large amount of SAH in perimesencephalic cistern is the single most important predisposing factor developing the progressed SDHC.