Hydrogel coil-related delayed hydrocephalus in patients with unruptured aneurysms.
OBJECTIVE
Because of high recanalization rates associated with wide-necked intracranial aneurysms treated with bare platinum coils, hydrogel coils (HydroCoil, MicroVention, Inc.) have been developed. Hydrogel coils undergo progressive expansion once exposed to the physiological environment of blood and increase overall aneurysm filling.


METHODS
The authors retrospectively reviewed their series of patients with unruptured aneurysms treated between 1998 and 2006 and who underwent placement of bare platinum and hydrogel coils for cerebral aneurysms. They examined the incidence of delayed hydrocephalus as related to coil type. In a subgroup of patients in which preand postprocedure CT and MR imaging studies were available, the authors quantitatively analyzed the ventricular size change after hydrogel coils were placed.


RESULTS
Four of 29 patients treated with hydrogel coils developed symptomatic hydrocephalus 2-6 months after the intervention compared with 0 of 26 treated with bare platinum coils alone. The difference in ventricular size between the subgroups in which pre- and postprocedure imaging was performed was found to be statistically significant (p < 0.05). All 4 HydroCoil-treated patients in whom hydrocephalus developed required placement of a shunt.


CONCLUSIONS
A 14% incidence (95% confidence interval 3.9-31.7%) of hydrocephalus in patients with unruptured aneurysm undergoing embolization with hydrogel coils was discovered. This incidence is much higher than previously reported. The mechanism by which hydrogel coils may induce hydrocephalus remains poorly understood.
Marchan
Edward M
EM
Department of Neurosurgery, Allegheny Neuroscience Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA. edmarchan@gmail.com
Sekula
Raymond F
RF
Ku
Andrew
A
Williams
Robert
R
O'Neill
Brent R
BR
Wilberger
Jack E
JE
Quigley
Matthew R
MR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000295:instrumentation*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology / Q000209:etiology*; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate; D015994:Incidence; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010984:Platinum; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D013997:Time Factors
D020136:Hydrogel, Polyethylene Glycol Dimethacrylate; D010984:Platinum