BACKGROUND Acute and delayed hydrocephalus are common sequelae following aneurysmal subarachnoid haemorrhage. AIMS To identify factors that may influence cerebrospinal fluid diversion either temporarily or permanently in order to guide clinical judgement. METHODS Patients treated in our unit between 01/2014 until 12/2017 with aneurysmal SAH were retrospectively analysed to identify significant factors predisposing to CSF diversion. RESULTS 242 patients were analysed (180F, 62M) with mean age 56 years over 36 months. 31 % patients had EVD inserted and 12 % received shunts. 19 patients had EVDs prior to their shunt. 11.8 % patients received serial lumbar puncture. Higher WFNS (P<0.05) and Fisher grade (P<0.05) were associated with increased rates of EVD insertion and shunting. Higher WFNS and Fisher scores were observed within posterior circulation aneurysms. Lower GCS and higher WFNS had significant correlation towards early shunting (P<0.05). EVD infection predisposes to higher rates of shunt conversion (P<0.05). Factors predisposing to post aneurysmal subarachnoid haemorrhage hydrocephalus and CSF drainage included aneurysm location in posterior circulation (P<0.05), increasing relative need of EVD insertion by 185 % and shunting by 240 %. Basilar tip aneurysms had even higher incidence of shunting (42 % of all posterior circulation aneurysms). Posterior circulation aneurysms had significantly higher risk of requiring EVD insertion, with 48 % of aneurysms in the posterior circulation compared to 25 % in the anterior circulation requiring EVDs (P<0.05). Incidence of posterior circulation aneurysms increases with age (>50(P<0.05)). CONCLUSION Our study demonstrated factors that may predict chronic post aneurysmal subarachnoid haemorrhage hydrocephalus (PASHH) in patients that will ultimately need timely intervention.

中文翻译：

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动脉瘤性蛛网膜下腔出血后慢性分流依赖性脑积水的危险因素

背景急性和迟发性脑积水是动脉瘤性蛛网膜下腔出血后常见的后遗症。目的 确定可能暂时或永久影响脑脊液分流的因素，以指导临床判断。方法 对 2014 年 1 月 1 日至 2017 年 12 月在我们单位接受治疗的动脉瘤性 SAH 患者进行回顾性分析，以确定导致 CSF 转移的重要因素。结果 分析了 242 名患者（180F，62M），平均年龄 56 岁，超过 36 个月。31% 的患者植入了 EVD，12% 的患者接受了分流术。19 名患者在分流前患有 EVD。11.8% 的患者接受了连续腰椎穿刺。较高的 WFNS（P<0.05）和 Fisher 等级（P<0.05）与 EVD 插入和分流率增加有关。在后循环动脉瘤中观察到较高的 WFNS 和 Fisher 评分。较低的GCS和较高的WFNS与早期分流显着相关（P<0.05）。EVD 感染倾向于较高的分流转换率（P<0.05）。导致动脉瘤性蛛网膜下腔出血和脑积水引流的因素包括动脉瘤位于后循环（P<0.05）、EVD 插入的相对需要增加 185% 和分流增加 240%。基底动脉瘤的分流发生率甚至更高（占所有后循环动脉瘤的 42%）。后循环动脉瘤需要置入 EVD 的风险显着更高，后循环动脉瘤的比例为 48%，而前循环动脉瘤为 25%（P<0.05）。后循环动脉瘤的发病率随着年龄的增长而增加（>50（P<0.05））。结论 我们的研究证明了可能预测最终需要及时干预的患者的慢性动脉瘤后蛛网膜下腔出血脑积水 (PASHH) 的因素。