Hydrocephalus

Acute hydrocephalus (ventricular enlargement within 72 hr) is reported to occur in about 20% to 30% of patients (40-43). The ventricular enlargement is often accompanied by intraventricular blood (44,45), whereas hydrocephalus without intraventricular hemorrhage is associated with the amount and distribution of cisternal blood (46,47). Acute hydrocephalus is more frequent in patients with poor clinical grade and a higher Fischer grade (40-43).

The clinical significance of acute ventriculomegaly after SAH is uncertain, because many patients are apparently asymptomatic and do not deteriorate (48). Yet, in patients with diminished level of consciousness, 40% to 80% show some degree of improvement after ventriculostomy (45,48,49). Based on two small series, the placement of a ventriculostomy may (50) or may not (51) be associated with rebleeding.

Delayed hydrocephalus requiring permanent shunting procedures is reported at rates of 18% to 26% of surviving patients (42,52,53). The need for permanent CSF diversion is associated with older age, early ventriculomegaly, presence of intraventricular hemorrhage, poor clinical condition on presentation, and female gender (54-58). Two single center series suggest that routine fenestration of the lamina terminalis during microsurgical aneurysm repair reduces the incidence of chronic hydrocephalus (59,60). On the other hand, rates are no different in patients who undergo clipping or endovascular treatment of their aneurysms (52,53). Ventriculoatrial, ventriculoperitoneal, or lumboperitoneal shunts may improve clinical status in this group of patients (61,62 ).

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