Chronic shunt-dependent hydrocephalus after early surgical and early endovascular treatment of ruptured intracranial aneurysms

OBJECTIVE: The goal of this study was to document the influence of the trea tment method (early surgery versus early endovascular treatment) on the dev elopment of chronic shunt-dependent hydrocephalus in a series of 242 patien ts treated within 7 days after aneurysmal subarachnoid hemorrhage (SAH). METHODS: The following parameters were prospectively recorded in a computer ized database and retrospectively analyzed for association with chronic shu nt-dependent hydrocephalus: 1) Hunt and Hess grade, 2) Fisher computed tomo graphic grade, 3) incidence of repeat SAH, 4) aneurysm location, and 5) tre atment method (early surgery versus early endovascular treatment). RESULTS: Forty of 187 patients (21.4%) who survived the SAH and its neurolo gical and/or medical sequelae underwent definitive shunting for treatment o f chronic hydrocephalus. The rate of shunt dependency was positively correl ated with a higher Hunt and Hess grade (P < 0.001), a higher Fisher compute d tomographic grade (P = 0.003), the occurrence of intraventricular hemorrh age (P < 0.001), repeat SAH (P = 0.003), and aneurysms arising at the anter ior communicating artery (P < 0.001). CONCLUSION: The results of the present study indicate that the treatment me thod used does not affect the risk of the later development of chronic shun t-dependent hydrocephalus (early surgery, 23.2% [29 of 125]; early endovasc ular treatment, 17.7% [11 of 62]; P = 0.45).