Roles of cistern and cisternal hemorrhage in the occurrence of acute hydrocephalus after aneurysmal subarachnoid hemorrhage

Abstract

Objective To investigate the roles of cistern and cisternal hemorrhage in the occurrence of acute hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH). Methods The clinical data of 306 patients with aSAH diagnosed and treated surgically at the Department of Neurosurgery, Nanfang Hospital, Southern Medical University from May 2011 to January 2014 were analyzed retrospectively. Their clinical variables were analyzed with the univariate analysis and multivariate logistic regression analysis, and the blood volume of each cistern was analyzed quantitatively. Results Among of the 306 patients, 112 had acute hydrocephalus, and the incidence was 36.6%. Univariate analysis suggested that there were significant differences in six factors, including Fisher grade, intraventricular hemorrhage, location of aneurysm, sides of aneurysm, rebleeding, and treatment (P<0.05); multivariate logistic regression analysis showed that the location of aneurysm and intraventricular hemorrhage were its independent occurrence factors. In patients without intraventricular hemorrhage, the incidence of acute hydrocephalus was 22.4%, of which the blood volumes of interpeduncular cistern and right sylvian cistern were the maximum in the hydrocephalus group. Compared with the non-hydrocephalus group, there were significant differences (P=0.000; P=0.005). Conclusions Acute hydrocephalus after aSAH is the result of multiple factors working together. The location of aneurysm and intraventricular hemorrhage are its independent risk factors. The acute hydrocephalus after aSAH is an obstructive hydrocephalus. The location of cistern and the distribution of cisternal hemorrhage have important influences in the occurrence of acute hydrocephalus after aSAH. In aSAH patients without intraventricular hemorrhage, the larger the hematocele volume of the interpeduncular cistern and right sylvian cistern, the more prone to acute hydrocephalus Key words: Intracranial aneurysm; Subarachnoid hemorrhage; Hydrocephalus; Risk factors; Subarachnoid cistern; Hemorrhage