Predictors and outcomes of shunt-dependent hydrocephalus in patients with aneurysmal sub-arachnoid hemorrhage

One hundred and sixty-eight aneurysmal SAH patients were evaluated. Using functional scores, those without hydrocephalus upon arrival at the hospital were compared to those already with hydrocephalus on admission, those who developed it during hospitalization, and those who did not develop it throughout their hospital stay. The Glasgow Coma Score, modified Fisher SAH grade, and World Federation of Neurosurgical Societies grade were determined at the emergency room. Therapeutic outcomes immediately after discharge and 18？months after were assessed using the Glasgow Outcome Score.Hydrocephalus accounted for 61.9% (104/168) of all episodes, including 82 with initial hydrocephalus on admission and 22 with subsequent hydrocephalus. Both the presence of intra-ventricular hemorrhage on admission and post-operative intra-cerebral hemorrhage were independently associated with shunt-dependent hydrocephalus in patients without hydrocephalus on admission. After a minimum 1.5？years of follow-up, the mean Glasgow outcome score was 3.33？±？1.40 for patients with shunt-dependent hydrocephalus and 4.21？±？1.19 for those without.The presence of intra-ventricular hemorrhage, lower mean Glasgow Coma Scale score, and higher mean scores of the modified Fisher SAH and World Federation of Neurosurgical grading on admission imply risk of shunt-dependent hydrocephalus in patients without initial hydrocephalus. These patients have worse short- and long-term outcomes and longer hospitalization.Aneurysmal sub-arachnoid hemorrhage (SAH) still has high mortality and morbidity rates despite modern neurosurgical techniques, new powerful imaging modalities, and care of such patients [1]. An important neurologic complication is hydrocephalus [2-5], which can be either acute-onset on admission or progressive during the hospital stay [2-5]. The overall risk of hydrocephalus after aneurysmal SAH varies between 6% to 67% in different series [6,7] although only 10-20% of them will require permanent CSF dive