Management of hydrocephalus following SAH and ICH

Abstract

The development of hydrocephalus following aneurysmal subarachnoid hemorrhage (SAH), a well-known sequela of the SAH, was firstly documented by. Many investigators have well established the relationship between SAH and hydrocephalus, and two stages of the hydrocephalus have been recognized: acute one, observed immediately after onset, and chronic one. The incidence of post-SAH hydrocephalus has been reported to be 9-67%, and this wide range may be caused by the variation of the defining criteria of hydrocephalus as well as the effect of the different treatments for ruptured aneurysm. Several mechanisms have been proposed to explain the development of hydrocephalus following SAH. Cerebrospinal fluid (CSF) dynamics is of importance for the development of the hydrocephalus. Hydrocephalus in patients with SAH may be induced mainly by obstructive mechanisms after the sudden increase in the arterial blood into the subarachnoid space lead to resist CSF outflow or block CSF circulation within the ventricular system in acute stage and also may be caused mainly by absorptive problems attributable to impaired CSF absorption in chronic stage. Acute hydrocephalus is more frequent in patients with poor clinical grade and higher Fischer Scale scores. The insertion of external ventricular drainage (EVD) has been the standard care in the management of the acute post-SAH hydrocephalus, purposing primarily immediate improvement of the clinical condition, leading more suitable objection for curative surgical or endovascular intervention. Chronic hydrocephalus influences cognitive deficits and poorer neurological outcome and requires permanent CSF diversion.