Wael M. Nazeem

Department of Neurosurgery, Beni Suef University; Egypt

Background: Hydrocephalus is one of the common complications that occur with spontaneous subarachnoid hemorrhage with significant increase in the incidence of mortality or morbidity. On the other hand, putting a permanent ventriculo-peritoneal shunt has its risks in the acute period and later on. Objective: To verify that acute hydrocephalus associated with spontaneous subarachnoid hemorrhage may be transient, to evaluate a temporary protocol for its management, and to try to find out some selection criteria before proceeding to permanent shunting. Methods: Twenty five patients with acute hydrocephalus accompanying spontaneous subarachnoid hemorrhage were included. Patients were classified into two groups according to the final need for permanent cerebrospinal fluid (CSF) diversion. Two main protocols were employed as temporizing approach, lamina terminalis fenestration and ventriculosubgaleal shunt. Both groups were compared regarding the initial clinical condition, extent of subarachnoid hemorrhage and intraventricular hemorrhage, aneurysm location, patients’ age & gender. Results: 60% of patients didn’t require permanent shunt after 6 weeks from the ictus and 80 % of patients who required permanent shunt had thick or diffuse subarachnoid clot. Conclusion: Acute hydrocephalus associated with spontaneous subarachnoid hemorrhage can be transient and procedures for temporary CSF diversion such as fenestration of the lamina terminalis and ventriculo-subgaleal or external ventricular drain are effective and should be employed before proceeding for permanent shunting. [Egypt J Neurol Psychiat Neurosurg.  2012; 49(3): 283-288]

 Keywords: hydrocephalus, subarachnoid hemorrhage, lamina terminalis