THE RELATIONSHIP OF SUBARACHNOID HEMORRHAGE AND THE NEED FOR POSTOPERATIVE SHUNTING

The incidence of chronic hydrocephalus requiring shunting after aneury smal 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 a nd underwent 116 surgical procedures for aneurysm clipping were evalua ted retrospectively to determine the incidence of chronic hydrocephalu s. Chronic hydrocephalus was defined as clinically and radiographicall y demonstrated hydrocephalus that lasted 2 weeks or longer after the o riginal hemorrhage and that required shunting. All SAH patients were m anaged in a similar fashion with induced hypervolemia, relative hemodi lution, and hypertension complemented by a course of calcium channel b lockers. 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 s hunt placement secondary to chronic hydrocephalus. There were no stati stically significant relationships between chronic hydrocephalus and p atient age or gender, aneurysm type and size, or use of a perioperativ e drain. There was a high clinical correlation between chronic hydroce phalus and admission Hunt and Hess grades and Fisher grades (p < 0.05) . All of the patients who survived a second bleeding episode and almos t 46% of the patients who presented with intraventricular hemorrhage r equired placement of a VP shunt. The authors pre sent predictive table s of chronic hydrocephalus based on the patient's admission Hunt and H ess grade and Fisher classification.