Risk factors for SDHC in aneurysmal subarachnoid hemorrhage patients

GUO Fang; ZHANG Ming; LI Zhongzhen; LIANG Enhe

Abstract：Objective The risk factors for shunt-dependent hydrocephalus ( SDHC ) in aneurysmal subarachnoid hemorrhage (aSAH) patients are discussed and the influence of microsurgical clipping or endovascular coil embolization treatment for SDHC in aSAH patients are compared according to Fisher grading system.Methods A retrospective review was conducted in 768 patients with aSAH who underwent microsurgical clipping or endovascular coiling in our hospital from July 2011 to June 2014.The patients were divided into two groups ( shunt group, 151 patients;non-shunt group, 617 patients ) and risk factors for SDHC were analyzed.The effects of two different treatments for aSAH patients with SDHC according to Fisher grading system were analyzed.Results Independent risk factors for SDHC after aSAH were as follows:≥40 years;Hunt-Hess gradeⅢ, IV or V;Fisher grade III or IV;acute hydrocephalus and intraventricular hemorrhage (IVH).In Fisher gradeⅡpatients, the coiling group showed lower incidence of SDHC, while in Fisher grade IV patients, the clipping group showed lower incidence of SDHC. Conclusion A significant higher rate of SDHC is observed for senior patients with poor initial neurological status, acute hydrocephalus and intraventricular hemorrhage.Fisher gradeⅡpatient prefers endovascular treatment and Fisher grade IV patient prefer microsurgical treatment, which reduce the incidence of SDHC and improve the prognosis of patients.For patients with Fisher gradeⅠandⅢ, there is no significant difference between two different treatments for SDHC.