Clipping or coiling of ruptured cerebral aneurysms and shunt-dependent hydrocephalus |
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Authors: | Varelas Panayiotis Helms Ann Sinson Grant Spanaki Marianna Hacein-Bey Lotfi |
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Institution: | (1) Department of Neurology, Medical College of Wisconsin, Milwaukee, WI;(2) Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI;(3) Department of Radiology, Medical College of Wisconsin, Milwaukee, WI;(4) Departments of Neurology and Neurosurgery, Henry Ford Hospital, 2799 West Grand Boulevard, 48202-2689 Detroit, MI |
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Abstract: | Background Hydrocephalus may develop either early in the course of aneurysmal subarachnoid hemorrhage (SAH) or after the first 2 weeks.
Because the amount of SAH is a predictor of hydrocephalus, the two available aneurysmal treatments, clipping or coiling, may
lead to differences in the need for cerebrospinal fluid (CSF) diversion, as only surgery permits clot removal.
Methods Hospital and University Hospitals Consortium (UHC) databases were used to retrieve data on all patients admitted to our hospital
with aneurysmal SAH during the last 4 years. The incidence of permanent ventricular shunt (VS) according to treatment modality
used was evaluated.
Results One hundred eighty-eight patients were admitted with aneurysmal SAH. Coiling was performed on 48 (26%) and clipping on 135
(73.8%) patients. Fifty-six (31%) patients required CSF diversion. External ventricular drain was placed in 30 (22.2%) clipped
and 13 (27.1%) coiled patients (p=0.5), and VS in 6 patients of the two treatment groups (4.4 versus 12.5%, respectively; p=0.08). Patients requiring VS had longer UHC-expected hospital length of stay (LOS), as well as observed ICU and hospital
LOS, compared to patients with temporary or no CSF diversion (24±14 versus 15±8, 20.5±9 versus 11±7, and 30±13 versus 16±11
days, respectively; p≤0.01). In a logistic regression model, VS was independently associated with rebleeding, external ventricular drain placement,
coiling, and UHC-expected LOS (odds ratios, 95% confidence interval 12.1, 2.3–62.6, 6.9, 1.6–30, 6.25, 1.3–29, and 1.1, 1.02–1.14,
respectively).
Conclusions One-third of patients admitted with aneurysmal SAH require temporary or permanent CSF diversion. Permanent shunting was found
to be associated with coiling in our patient population. |
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Keywords: | Endovascular craniotomy subarachnoid hemorrhage cerebral aneurysm clipping coiling shunt hydrocephalus |
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