Endoscopic third ventriculostomy for hydrocephalus after aneurysmal subarachnoid hemorrhage
see External ventricular drain for hydrocephalus after aneurysmal subarachnoid hemorrhage
see also Endoscopic third ventriculostomy for hydrocephalus after perimesencephalic subarachnoid hemorrhage.
Ventriculoperitoneal shunt implantation should be the main treatment for hydrocephalus after aneurysmal subarachnoid hemorrhage, but ETV can be employed as a temporary intervention in certain conditions, such as during the waiting period for the clearance of aneurysmal subarachnoid hemorrhage 1).
Fukuhara et al. evaluated the efficacy of ETV for hydrocephalus appearing within one month after aneurysmal SAH. This prospective study evaluated a total of 118 patients admitted to the hospital with aneurysmal SAH. Nine of 66 surgically treated patients suffered hydrocephalus within one month after aneurysmal SAH and 8 underwent ETV. Seven of these 8 patients showed no further ventricular enlargement or deterioration in consciousness, and required no External Ventricular Drainage at least temporarily, and could commence early physical rehabilitation. Four patients also experienced cognitive improvements after ETV, but none made a full cognitive recovery. Ventriculoperitoneal (VP) shunt was implanted for one patient who did not respond to ETV, and the necessity of VP shunt was evaluated including the CSF removal test for the other patients, due to residual cognitive impairment even after initiating the rehabilitation. Five of the 8 patients eventually had VP shunts implanted, and 3 patients, including two patients who improved cognitively after ETV, had further cognitive improvements. ETV for hydrocephalus following aneurysmal SAH is likely to help manage intracranial pressure. ETV may improve cognitive impairment in some patients, but whether the maximum resolution is obtained only with ETV remains uncertain. Ventriculoperitoneal shunt implantation should be the main treatment for hydrocephalus after aneurysmal SAH, but ETV can be employed as a temporary intervention in certain conditions, such as during the waiting period for the clearance of aneurysmal SAH 2).
A cross-sectional retrospective study was carried out to survey all patients with confirmed aneurysmal subarachnoid hemorrhage operated from March 2011 to September 2016 in an academic vascular center (Rasoul Akram Hospital). Of a total of 151 patients, 72 patients were male and 79 were female. The mean age of the participants was 51 years. A transiently CSF diversion (EVD - external ventricular drainage) was performed (the acute hydrocephalus rate) on 21 patients (13.9%). In 36 patients (23.8%), aneurysm occlusion with LTF (lamina terminalis fenestration) and in 115 patients (76.2%) only aneurysm occlusion surgery was performed. In hydrocephalus follow-up after surgery, 13 (12%) patients needed shunt insertion (the rate of shunt-needed hydrocephalus). The statistical analysis demonstrated no significant relation between LTF and shunt-needed hydrocephalus. Confirmation of the hypothesis that LTF may decrease the rate of shunt-needed hydrocephalus can significantly decrease morbidity, mortality, and treatment costs of shunting (that is a simple, but a potentially dangerous procedure). So, it is advised to plan and perform an RCT (randomized controlled trial) that can remove the confounding factors, match the groups, and illustrate the exact effect of endoscopic third ventriculostomy for hydrocephalus after aneurysmal subarachnoid hemorrhage 3).