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Transient acute hydrocephalus after aneurysmal subarachnoid hemorrhage and aneurysm embolization: a single-center experience

  • Interventional Neuroradiology
  • Published:
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Abstract

Purpose

Acute hydrocephalus is a common complication after aneurysmal subarachnoid hemorrhage (aSAH). It can be self-limiting or require cerebrospinal fluid diversion. We aimed to determine the transient acute hydrocephalus (TAH) rate in patients with aSAH treated endovascularly and evaluate its predictive factors.

Methods

A retrospective review of 357 patients with aSAH who underwent endovascular treatment from March 2013 to December 2019 was performed. Clinical and radiographic data were analyzed and risk factors with potential significance for acute hydrocephalus were identified. We constructed a new risk score, the Drainage Or Transiency of Acute Hydrocephalus after Aneurysmal SAH (DOTAHAS) score, that may differentiate patients who would experience TAH from those needing surgical interventions.

Results

Acute hydrocephalus occurred in 129 patients (36%), out of whom in 66 patients (51%) it was self-limiting while 63 patients (49%) required external ventricular drainage placement. As independent risk factors for acute hydrocephalus, we identified older age, poor initial clinical condition, aSAH from posterior circulation, and the extent of cisternal and intraventricular hemorrhage. The following three factors were shown to predict acute hydrocephalus transiency and therefore included in the DOTAHAS score, ranging from 0 to 7 points: Hunt and Hess grade ≥ 3 (1 point), modified Fisher grade 4 (2 points), and Ventricular Hijdra Sum Score (vHSS) ≥ 6 (4 points). Patients scoring ≥ 3 points had significantly higher risk for EVD (P < 0.0001) than other patients.

Conclusion

The newly developed DOTAHAS score can be useful in identifying patients with transient acute hydrocephalus. Further score evaluation is needed.

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References

  1. Chen S, Luo J, Reis C et al (2017)Hydrocephalus after subarachnoid hemorrhage: pathophysiology, diagnosis, and treatment.Biomed Res Int 2017.https://doi.org/10.1155/2017/8584753

  2. Wilson CD, Safavi-Abbasi S, Sun H et al (2017) Meta-analysis and systematic review of risk factors for shunt dependency after aneurysmal subarachnoid hemorrhage. J Neurosurg 126:586–595. https://doi.org/10.3171/2015.11.JNS152094

    Article  PubMed  Google Scholar 

  3. Adams H, Ban VS, Leinonen V et al (2016) Risk of shunting after aneurysmal subarachnoid hemorrhage: a collaborative study and initiation of a consortium. Stroke 47:2488–2496. https://doi.org/10.1161/STROKEAHA.116.013739

    Article  PubMed  Google Scholar 

  4. Connolly ES, Rabinstein AA, Carhuapoma JR et al (2012) Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American heart association/American stroke association. Stroke 43:1711–1737. https://doi.org/10.1161/STR.0b013e3182587839

    Article  PubMed  Google Scholar 

  5. Gigante P, Hwang BY, Appelboom G et al (2010) External ventricular drainage following aneurysmal subarachnoid haemorrhage. Br J Neurosurg 24:625–632. https://doi.org/10.3109/02688697.2010.505989

    Article  PubMed  Google Scholar 

  6. Jabbarli R, Bohrer AM, Pierscianek D et al (2016) The CHESS score: a simple tool for early prediction of shunt dependency after aneurysmal subarachnoid hemorrhage. Eur J Neurol 23:912–918. https://doi.org/10.1111/ene.12962

    Article  CAS  PubMed  Google Scholar 

  7. van Gijn J, Hijdra A, Wijdicks EFM et al (1985) Acute hydrocephalus after aneurysmal subarachnoid hemorrhage. J Neurosurg 63:355–362. https://doi.org/10.3171/jns.1985.63.3.0355

    Article  PubMed  Google Scholar 

  8. Hasan D, Tanghe HLJ (1992) Distribution of cisternal blood in patients with acute hydrocephalus after subarachnoid hemorrhage. Ann Neurol 31:374–378. https://doi.org/10.1002/ana.410310405

    Article  CAS  PubMed  Google Scholar 

  9. Mehta V, Holness RO, Connolly K et al (1996) Acute hydrocephalus following aneurysmal subarachnoid hemorrhage. Can J Neurol Sci 23:40–45. https://doi.org/10.1017/S0317167100039160

    Article  CAS  PubMed  Google Scholar 

  10. Graff Radford NR, Torner J, Adams HP, Kassell NF (1989) Factors associated with hydrocephalus after subarachnoid hemorrhage: a report of the cooperative aneurysm study. Arch Neurol 46:744–752. https://doi.org/10.1001/archneur.1989.00520430038014

    Article  CAS  PubMed  Google Scholar 

  11. Hasan D, Vermeulen M, Wijdicks EFM et al (1989) Management problems in acute hydrocephalus after subarachnoid hemorrhage. Stroke 20:747–753. https://doi.org/10.1161/01.STR.20.6.747

    Article  CAS  PubMed  Google Scholar 

  12. Diesing D, Wolf S, Sommerfeld J et al (2018) A novel score to predict shunt dependency after aneurysmal subarachnoid hemorrhage. J Neurosurg 128:1273–1279. https://doi.org/10.3171/2016.12.JNS162400

    Article  PubMed  Google Scholar 

  13. Fisher CM, Kistler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6:1–9. https://doi.org/10.1227/00006123-198001000-00001

    Article  CAS  PubMed  Google Scholar 

  14. Frontera JA, Claassen J, Schmidt JM et al (2006) Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified Fisher scale. Neurosurgery 59:21–26. https://doi.org/10.1227/01.NEU.0000218821.34014.1B

    Article  PubMed  Google Scholar 

  15. Wilson DA, Nakaji P, Abla AA et al (2012) A simple and quantitative method to predict symptomatic vasospasm after subarachnoid hemorrhage based on computed tomography: beyond the Fisher scale. Neurosurgery 71:869–875. https://doi.org/10.1227/NEU.0b013e318267360f

    Article  PubMed  Google Scholar 

  16. Hijdra A, Brouwers P, Vermeulen M, Van GJ (1990) Grading the amount of blood on computed tomograms after subarachnoid hemorrhage. Stroke 21:1156–1161. https://doi.org/10.1161/01.STR.21.8.1156

    Article  CAS  PubMed  Google Scholar 

  17. Bretz JS, Von Dincklage F, Woitzik J et al (2017) The Hijdra scale has significant prognostic value for the functional outcome of Fisher grade 3 patients with subarachnoid hemorrhage. Clin Neuroradiol 27:361–369. https://doi.org/10.1007/s00062-016-0509-0

    Article  PubMed  Google Scholar 

  18. Molyneux AJ, Kerr RS, Yu LM, International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group et al (2005) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366:809–817. https://doi.org/10.1016/S0140-6736(05)67214-5

    Article  PubMed  Google Scholar 

  19. Jartti P, Karttunen A, Jartti A et al (2004) Factors related to acute hydrocephalus after subarachnoid hemorrhage. Acta Radiol 45:333–339. https://doi.org/10.1080/02841850410004274

    Article  CAS  PubMed  Google Scholar 

  20. Toma AK, Holl E, Kitchen ND, Watkins LD (2011) Evans’ index revisited: the need for an alternative in normal pressure hydrocephalus. Neurosurgery 68:939–944. https://doi.org/10.1227/NEU.0b013e318208f5e0

    Article  PubMed  Google Scholar 

  21. Dupont S, Rabinstein AA (2013) CT evaluation of lateral ventricular dilatation after subarachnoid hemorrhage: baseline bicaudate index values. Neurol Res 35:103–106. https://doi.org/10.1179/1743132812Y.0000000121

    Article  PubMed  Google Scholar 

  22. Kukuljan M, Kolic Z, Bonifacic D et al (2009) Normal bicaudate index by aging. Curr Med Imaging Rev 5:72–74. https://doi.org/10.2174/157340509788185351

    Article  Google Scholar 

  23. Fried HI, Nathan BR, Rowe AS et al (2016) The insertion and management of external ventricular drains: an evidence-based consensus statement: a statement for healthcare professionals from the Neurocritical Care Society. Neurocrit Care 24:61–81. https://doi.org/10.1007/s12028-015-0224-8

    Article  Google Scholar 

  24. Konovalov A, Shekhtman O, Pilipenko Y et al (2021) External ventricular drainage in patients with acute aneurysmal subarachnoid hemorrhage after microsurgical clipping: Our 2006–2018 Experience and a Literature Review. Cureus 13:1–9. https://doi.org/10.7759/cureus.12951

    Article  Google Scholar 

  25. Orešković D, Klarica M (2011) Development of hydrocephalus and classical hypothesis of cerebrospinal fluid hydrodynamics: facts and illusions. Prog Neurobiol 94:238–258. https://doi.org/10.1016/j.pneurobio.2011.05.005

    Article  PubMed  Google Scholar 

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Funding

No funding was received for this study

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Neuroradiology, University Hospital Centre Zagreb, Kispaticeva Street 12, 10 000, Zagreb, Croatia

    Ivan Jovanović & Danilo Gardijan

  2. Department of Neurosurgery, School of Medicine, University Hospital Centre Zagreb, University of Zagreb, Affiliated Partner of EURACAN, Zagreb, Croatia

    Jakob Nemir

  3. Andrija Stampar School of Public Health, Department for Environmental Health, Occupational and Sports Medicine, School of Medicine, University of Zagreb, Zagreb, Croatia

    Milan Milošević

  4. Department of Neurology, School of Medicine, University Hospital Centre Zagreb, University of Zagreb, Zagreb, Croatia

    Zdravka Poljaković

  5. Department of Pharmacology and Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia

    Marijan Klarica

  6. Department of Diagnostic and Interventional Neuroradiology, School of Medicine, University Hospital Centre Zagreb, University of Zagreb, Zagreb, Croatia

    David Ozretić & Marko Radoš

Authors
  1. Ivan Jovanović
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  2. Jakob Nemir
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  3. Danilo Gardijan
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  4. Milan Milošević
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  6. Marijan Klarica
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Correspondence to Ivan Jovanović.

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All the authors declare that they have no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Jovanović, I., Nemir, J., Gardijan, D. et al. Transient acute hydrocephalus after aneurysmal subarachnoid hemorrhage and aneurysm embolization: a single-center experience. Neuroradiology 63, 2111–2119 (2021). https://doi.org/10.1007/s00234-021-02747-2

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  • DOI: https://doi.org/10.1007/s00234-021-02747-2

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