The relationship of subarachnoid hemorrhage and the need for postoperative shunting

Fernando L. Vale, Edwin L. Bradley, Winfield S. Fisher

Research output: Contribution to journalArticle

151 Citations (Scopus)

Abstract

The incidence of chronic hydrocephalus requiring shunting after aneurysmal subarachnoid hemorrhage (SAH) is not precisely known. The authors investigated whether the need for ventriculoperitoneal (VP) shunting can be predicted by initial Hunt and Hess grade or Fisher computerized tomography score. One hundred eight patients who presented with SAH and underwent 116 surgical procedures for aneurysm clipping were evaluated retrospectively to determine the incidence of chronic hydrocephalus. Chronic hydrocephalus was defined as clinically and radiographically demonstrated hydrocephalus that lasted 2 weeks or longer after the original hemorrhage and that required shunting. All SAH patients were managed in a similar fashion with induced hypervolemia, relative hemodilution, and hypertension complemented by a course of calcium channel blockers. The majority of patients underwent perioperative extracranial ventricular drainage to allow intraoperative brain relaxation and to assist intracranial pressure management. The overall mortality rate of the study group was 17%. Of the surviving patients, 20% underwent VP shunt placement secondary to chronic hydrocephalus. There were no statistically significant relationships between chronic hydrocephalus and patient age or gender, aneurysm type and size, or use of a perioperative drain. There was a high clinical correlation between chronic hydrocephalus and admission Hunt and Hess grades and Fisher grades (p < 0.05). All of the patients who survived a second bleeding episode and almost 46% of the patients who presented with intraventricular hemorrhage required placement of a VP shunt. The authors present predictive tables of chronic hydrocephalus based on the patient's admission Hunt and Hess grade and Fisher classification.

Original languageEnglish (US)
Pages (from-to)462-466
Number of pages5
JournalJournal of neurosurgery
Volume86
Issue number3
DOIs
StatePublished - Mar 1997

Fingerprint

Subarachnoid Hemorrhage
Hydrocephalus
Ventriculoperitoneal Shunt
Hemorrhage
Aneurysm
Hemodilution
Patient Admission
Incidence
Intracranial Pressure
Calcium Channel Blockers
Drainage
Tomography
Hypertension
Mortality
Brain

Keywords

  • Fisher computerized tomography classification
  • Hunt and Hess scale
  • aneurysm
  • hydrocephalus
  • subarachnoid hemorrhage
  • ventriculoperitoneal shunt

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

The relationship of subarachnoid hemorrhage and the need for postoperative shunting. / Vale, Fernando L.; Bradley, Edwin L.; Fisher, Winfield S.

In: Journal of neurosurgery, Vol. 86, No. 3, 03.1997, p. 462-466.

Research output: Contribution to journalArticle

Vale, Fernando L. ; Bradley, Edwin L. ; Fisher, Winfield S. / The relationship of subarachnoid hemorrhage and the need for postoperative shunting. In: Journal of neurosurgery. 1997 ; Vol. 86, No. 3. pp. 462-466.
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