Shunt-dependent Hydrocephalus After Rupture Of Intracranial Aneurysms:Clipping Versus Coiling And Risk Factors

Objective:1.To compare the effects of clipping and coiling on the development of shunt-dependent hydrocephalus in patients with ruptured intracranial aneurysms; 2.To study the risk factors of shunt-dependent hydrocephalus in patients with aneurysmal subarachnoid hemorrhage.Methods:we collected 212 patients with aneurysmal subarachnoid hemorrhage who fulfilled the inclusive and exclusive criteria in the Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University from January 1st 2014 to October 31st 2014.We reviewed the medical records and collected basic information such as gender, age, MAP at admission,Hunt-Hess grade, Fisher grade, intraventricular hemorrhage, acute hydrocephalus, aneurysmal location, aneurysmal diameter, meningitis, treatment modalities. By reviewing the radiological records of patients, collected the Digital Subtraction Angiography and head CT scans within 72 hours of aneurysmal subarachnoid hemorrhage. Measured the aneurysmal diameter, distinguished the aneurysmal locations and assessed the Fisher grade、acute hydrocephalus and intraventricular hemorrhage. Followed up the patients and their families by telephone to know whether they had permanent shunt surgery. According to treatment modalities, we divided the patients into clipping and coiling groups, then statistical analysis of data to compare the characteristics and incidence of shunt-dependent hydrocephalus between the two groups.Then divided the patients into SDH (shunt-dependent hydrocephalus)and no SDH groups, tested every possible risk factors significantly, and gave these statistically significant factors logistic regression analysis. Finally we found the independent risk factors of shunt-dependent hydrocephalus.Results:Among the 212 patients with aneurysmal subarachnoid hemorrhage who fulfilled the inclusive and exclusive criteria, clipping were performed on 102 patients and coiling on 110 patients. There were 76 male and 133 female patients. The average age was61±4.24years old.No difference was found in age, gender, MAP, Hunt-Hess grade, Fisher grade intraventricular hemorrhage,acute hydrocephalus between clipping andcoiling groups. Most of aneurysms between 5 and 10 mm were coiled endovascularly. Anterior circulation aneurysms occupied the main location in both the two groups(99% and 92.73%). ACA-AcoA aneurysms were most common, then ICA-PcoA aneurysms and MCA aneurysms. Most of the posterior circulation aneurysms(88.89%)were coiled endovascularly.The incidence of meningitis between clipping group (9.80%)and coiling group(2.73%) was statistically different(P< 0.01).The whole incidence of shunt-dependent hydrocephalus was 17.9%. After clipping 20.59% and after coiling 15.45% of patients developed shunt-dependent hydrocephalus. There was no statistically significant difference in the incidence of shunt-dependent hydrocephalus between the two groups(P=0.33). By the univariate analysis, Hunt-Hess grade, Fisher grade intraventricular hemorrhage,acute hydrocephalus, meningitis were related to shunt -dependent hydrocephalus(P<0.05). In a logistic regression model, intraventricular hemorrhage,acute hydrocephalus and meningitis were independent risk factors of shunt-dependent hydrocephalus.Conclusion:There was no statistically significant difference in the incidence of shunt-dependent hydrocephalus between clipping and coiling groups. Several factors lead to the development of shunt-dependent hydrocephalus in patients with ruptured intracranial aneurysms. Univariate factors of shunt-dependent hydrocephalus include Hunt-Hess grade, Fisher grade intraventricular hemorrhage,acute hydrocephalus, meningitis. Intraventricular hemorrhage,acute hydrocephalus and meningitis were independent risk factors of shunt-dependent hydrocephalus by logistic regression analysis. Given the single-center retrospective study,the result needs further validation by large RCT studies.