Hydrocephalus as a Complication of Subarachnoid Hemorrhage

Authors: L. Jurák 1;  O. Bradáč 2;  M. Kaiser 1;  R. Brabec 1;  P. Buchvald 1;  L. Endrych 3;  P. Suchomel 1
Authors‘ workplace: Neurochirurgické oddělení, Krajská nemocnice Liberec, a. s. 1;  Neurochirurgická klinika 1. LF UK, IPVZ a ÚVN Praha 2;  Radiologické oddělení, Krajská nemocnice Liberec, a. s. 3
Published in: Cesk Slov Neurol N 2013; 76/109(1): 70-75
Category: Original Paper


Hydrocephalus is a relatively common complication of subarachnoid hemorrhage. Hydrocephalus is classified as acute, subacute or chronic according to the time elapsed from the onset of subarachnoid hemorrhage. Etiology involves either an obstruction of cerebrospinal fluid (CSF) flow or disturbed CSF resorption. Hydrocephalus in urgent situations is usually treated with temporary external ventricular or lumbar draina­­ge. Chronic forms are managed with permanent shunting, usually a ventriculoperitoneal shunt. We performed a retrospective analysis of 350 patients admitted to our centre with the diagnosis of subarachnoid hemorrhage over a 10-year period, from 1999 to 2008. Hydrocephalus occurred in 13.4% of patients with subarachnoid hemorrhage. Hydrocephalus was more frequent in patients with the initial Fisher score three and more, with aneurysm managed with endovascular treatment and with a history of temporary cerebrospinal fluid drainage. The median time from an onset of subarachnoid hemorrhage to development of hydrocephalus was 20 days.

Key words:
hydrocephalus – subarachnoid hemorrhage – complications – risk factors

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


1. Bagley C jr. Blood in the cerebrospinal fluid: resultant functional and organic alterations in the central nervous system. AO experimental data. Arch Surg 1928; 17: 18–38.

2. Graff-Radford NR, Torner J, Adams HP jr, Kassell NF. Factors associated with hydrocephalus after subarachnoid hemorrhage. A report of the Cooperative Aneurysm Study. Arch Neurol 1989; 46(7): 744–752.

3. Vale FL, Bradley EL, Fisher WS 3rd. The relationship of subarachnoid hemorrhage and the need for postoperative shunting. J Neurosurg 1997; 86(3): 462–466.

4. Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 1968; 28(1): 14–20.

5. Teasdale GM, Drake CG, Hunt W, Kassell N, Sano K, Pertuiset B et al. A universal subarachnoid hemor­rhage scale: report of a committee of the World Federation of Neurosurgical Societies. J Neurol Neurosurg Psychiatry 1988; 51(11): 1457.

6. Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 1980; 6(1): 1–9.

7. Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet 1975; 1(7905): 480–484.

8. Mohapl M, Kramář F, Beneš V. Hydrocefalus jako následek subarachnoidálního krvácení – review. Cesk Slov Neurol N 2004; 67/100(5): 309–319.

9. Mohapl M, Kramář F, Beneš V. Hydrocefalus po subarachnoidálním krvácení – vliv modality léčby aneuryzmatu. Cesk Slov Neurol N 2007; 70/103(3): 284–289.

10. Vaverka M, Charamza J, Kikalová K, Krahulík D. Morfologická studie lamina terminalis a její klinický význam. Cesk Slov Neurol N 2006; 69/102(3): 217–221.

11. Widenka DC, Wolf S, Schürer L, Plev DV, Lumenta CB. Factors leading to hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurol Neurochir Pol 2000; 34 (Suppl 6): 56–60.

12. Vermeij FH, Hasan D, Vermeulen M, Tanghe HL, van Gijn J. Predictive factors for deterioration from hydrocephalus after subarachnoid hemorrhage. Neurology 1994; 44(10): 1851–1855.

13. Lin CL, Kwan AL, Howng SL. Acute hydrocephalus and chronic hydrocephalus with the need of postoperative shunting after aneurysmal subarachnoid hemor­rhage. Kaohsiung J Med Sci 1999; 15(3): 137–145.

14. Schmieder K, Koch R, Lücke S, Harders A. Factors influencing shunt dependency after aneurysmal subarachnoid haemorrhage. Zentralbl Neurochir 1999; 60(3): 133–140.

15. Dorai Z, Hynan LS, Kopitnik TA, Samson D. Factors related to hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery 2003; 52(4): 763–769.

16. Sheehan JP, Polin RS, Sheehan JM, Baskaya MK, Kassell NF. Factors associated with hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery 1999; 45(5): 1120–1127.

17. Yoshioka H, Inagawa T, Tokuda Y, Inokuchi F. Chronic hydrocephalus in elderly patients following subarachnoid hemorrhage. Surg Neurol 2000; 53(2): 119–124.

18. Gruber A, Reinprecht A, Bavinzski G, Czech T, Richling B. Chronic shunt-dependent hydrocephalus after early surgical and early endovascular treatment of ruptured intracranial aneurysms. Neurosurgery 1999; 44(3): 503–509.

19. Demirgil BT, Tugcu B, Postalci L, Guclu G, Dalgic A, Oral Z. Factors leading to hydrocephalus after aneurysmal subarachnoid hemorrhage. Minim Invasive Neurosurg 2003; 46(6): 344–348.

20. Jartti P, Karttunen A, Isokangas JM, Jartti A, Koskelainen T, Tervonen O. Chronic hydrocephalus after neurosurgical and endovascular treatment of ruptured intracranial aneurysms. Acta Radiol 2008; 49(6): 680–686.

21. Hirashima Y, Hamada H, Hayashi N, Kuwayama N, Origasa H, Endo S. Independent predictors of late hydrocephalus in patients with aneurysmal sub­arachnoid hemorrhage – analysis by multivariate logistic regression model. Cerebrovasc Dis 2003; 16(3): 205–210.

22. Levy EI, Scarrow AM, Firlik AD, Kanal E, Rubin G, Kirby L et al. Development of obstructive hydrocephalus with lumboperitoneal shunting following sub­arachnoid hemorrhage. Clin Neurol Neurosurg 1999; 101(2): 79–85.

23. Kang S. Efficacy of lumbo-peritoneal versus ventriculo-peritoneal shunting for management of chronic hydrocephalus following aneurysmal subarachnoid haemorrhage. Acta Neurochir (Wien) 2000; 142(1): 45–49.

24. Komotar RJ, Olivi A, Rigamonti D, Tamargo RJ. Microsurgical fenestration of the lamina terminalis reduces the incidence of shunt-dependent hydrocefalus after aneurysmal subarachnoid hemorrhage. Neurosurgery 2002; 51(6): 1403–1412.

25. Komotar RJ, Hahn DK, Kim GH, Khandji J, Mocco J, Mayer SA et al. The impact of microsurgical fenestration of the lamina terminalis on shunt-dependent hydrocephalus and vasospasm after aneurysmal subarachnoid hemorrhage. Neurosurgery 2008; 62(1): 123–132.

26. Komotar RJ, Hahn DK, Kim GH, Starke RM, Garrett MC, Merkow MB et al. Efficacy of lamina terminalis fenestration in reducing shunt-dependent hydrocephalus following aneurysmal subarachnoid hemorrhage: a systematic review. Clinical article. J Neurosurg 2009; 111(1): 147–154.

27. Vaverka M. Fenestration of Lamina Terminalis and hydrocephalus after SAH. 14th European Congress of Neurosurgery; 2011 Oct 9–14; Rome, Italy.

28. Pietilä TA, Heimberger KC, Palleske H, Brock M. Influence of aneurysm location on the development of chronic hydrocephalus following SAH. Acta Neurochir (Wien) 1995; 137(1–2): 70–73.

29. Mehta V, Holness RO, Connolly K, Walling S, Hall R. Acute hydrocephalus following aneurysmal sub­arachnoid hemorrhage. Can J Neurol Sci 1996; 23(1): 40–45.

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