Journal of Cerebrovascular and Endovascular Neurosurgery

Korean Society of Cerebravascular Surgeons (대한뇌혈관외과학회)
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Does Neurosurgical Clipping or Endovascular Coiling Lead to More Cases of Delayed Hydrocephalus in Patients with Subarachnoid Hemorrhage?

  • Eom, Tae Oong (Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Park, Eun Suk (Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Park, Jun Bum (Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Kwon, Soon Chan (Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Sim, Hong Bo (Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Lyo, In Uk (Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Kim, Min Soo (Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine)
  • Received : 2018.03.26
  • Accepted : 2018.05.20
  • Published : 2018.06.30
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Abstract

Objective : We investigated whether clipping or endovascular treatment (EVT) can reduce the incidence of delayed hydrocephalus. We also investigated whether additional procedures, namely lumbar drainage and extra-ventricular drainage (EVD), decrease the incidence of delayed hydrocephalus in patients with subarachnoid hemorrhage (SAH). Materials and Methods : One-hundred and fifty-two patients who had undergone an operation for SAH were enrolled in this study. Clinical data, radiological data, and procedural data were investigated. Procedural data included the operating technique (clipping vs. EVT) and the use of additional procedures (no procedure, lumbar drainage, or EVD). Delayed hydrocephalus was defined as a condition in which the Evan's index was 0.3 or higher, as assessed using brain computed tomography more than 2 weeks after surgery, requiring shunt placement due to neurological deterioration. Results : Of the 152 patients, 45 (29.6%) underwent surgical clipping and 107 (70.4%) underwent EVT. Twenty-five (16.4%) patients developed delayed hydrocephalus. Age (p = 0.019), procedure duration (p = 0.004), and acute hydrocephalus (p = 0.030) were significantly correlated with the incidence of delayed hydrocephalus. However, the operation technique (p = 0.593) and use of an additional procedure (p = 0.378) were not significantly correlated with delayed hydrocephalus incidence. Conclusion : No significant difference in the incidence of delayed hydrocephalus was associated with operation technique or use of an additional procedure in patients with SAH. However, delayed hydrocephalus was significantly correlated with old age, long procedural duration, and acute hydrocephalus. Therefore, we recommend that additional procedures should be discontinued as soon as possible.

Keywords

Acknowledgement

Supported by : National Research Foundation of Korea (NRF)

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