title: Aneurysm location and clipping versus coiling for development of secondary normal-pressure hydrocephalus after aneurysmal subarachnoid hemorrhage: Japanese Stroke DataBank.
abstract: OBJECTIVE
  The present study aimed to investigate aneurysm locations and treatments for ruptured cerebral aneurysms associated with secondary normal-pressure hydrocephalus (sNPH) after subarachnoid hemorrhage (SAH) by using comprehensive data from the Japanese Stroke DataBank.
  
  
  METHODS
  Among 101,165 patients with acute stroke registered between 2000 and 2013, 4693 patients (1482 men, 3211 women) were registered as having had an SAH caused by a ruptured saccular aneurysm. Of them, 1448 patients (438 men and 1010 women; mean age 61.9 ± 13.4 years) who were confirmed to have or not have coexisting acute hydrocephalus and sNPH were included for statistical analyses. Locations of the ruptured aneurysms were subcategorized into 1 of the following 4 groups: middle cerebral artery (MCA; n = 354), anterior communicating artery and anterior cerebral artery (ACA; n = 496), internal carotid artery (ICA; n = 402), and posterior circulation (n = 130). Locations of 66 of the ruptured aneurysms were unknown/unrecorded. Treatments included craniotomy and clipping alone in 1073 patients, endovascular coil embolization alone in 285 patients, and a combination of coiling and clipping in 17 patients. The age-adjusted and multivariate odds ratios from logistic regression analyses were calculated after stratification using the Fisher CT scale to investigate the effects of the hematoma volume of SAH.
  
  
  RESULTS
  Acute hydrocephalus was confirmed in 593 patients, and 521 patients developed sNPH. Patients with a ruptured ACA aneurysm had twice the risk for sNPH over those with a ruptured MCA aneurysm. Those with an ACA aneurysm with Fisher Grade 3 SAH had a 9-fold-higher risk for sNPH than those with an MCA aneurysm with Fisher Grade 1 or 2 SAH. Patients with a ruptured posterior circulation aneurysm did not have any significant risk for sNPH. Clipping of the ruptured aneurysm resulted in twice the risk for sNPH over coil embolization alone.
  
  
  CONCLUSIONS
  Patients with low-grade SAH caused by a ruptured MCA aneurysm had a low risk for the development of sNPH. In contrast, patients with high-grade SAH caused by a ruptured ACA aneurysm had a higher risk for sNPH. Endovascular coiling might confer a lower risk of developing sNPH than microsurgical clipping.
authors.affiliation: Department of Neurosurgery, Stroke Center and Normal Pressure Hydrocephalus Center, and.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Yamada
authors.affiliation: Department of Neurosurgery, Stroke Center and Normal Pressure Hydrocephalus Center, and.
authors.forename: Masatsune
authors.initials: M
authors.lastname: Ishikawa
authors.affiliation: Department of Neurosurgery, Stroke Center and Normal Pressure Hydrocephalus Center, and.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yamamoto
authors.affiliation: Department of Neurology, Rakuwakai Otowa Hospital;
authors.forename: Tadashi
authors.initials: T
authors.lastname: Ino
authors.affiliation: Department of Neurology, Rakuwakai Misasagi Hospital, Kyoto; and.
authors.forename: Toru
authors.initials: T
authors.lastname: Kimura
authors.affiliation: Shimane University, Shimane, Japan.
authors.forename: Shotai
authors.initials: S
authors.lastname: Kobayashi
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D003399:Craniotomy; D016208:Databases, Factual; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000175:diagnosis / Q000453:epidemiology*; D002532:Intracranial Aneurysm / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000175:diagnosis / Q000628:therapy
keywords: ACA = anterior cerebral artery; ICA = internal carotid artery; MCA = middle cerebral artery; NPH = normal-pressure hydrocephalus; SAH = subarachnoid hemorrhage; WFNS = World Federation of Neurological Societies; acute hydrocephalus; endovascular coil embolization; sNPH = secondary NPH; secondary NPH; subarachnoid hemorrhage; vascular disorders