Management of Subdural Fluid Collection Following Surgery for a Ruptured Aneurysm

초록

INTRODUCTION: A subdural fluid collection after an aneurysm repair has a variable natural course. In this retrospective study, we present an analysis of cases with SFCs after aneurysm repairs and tried to set up a management plans. METHODS: Two hundred eighty-eight patients underwent open aneurysm surgery for ruptured aneurysms. The clinical and radiographic characteristics and outcomes of the 288 patients were retrospectively analyzed. Among them, 97 patients (33.7%) had impaired cerebrospinal fluid circulation as form of subdural fluid collection or hydrocephalus at postoperative period. We categorized these patients into 3 groups. Group I (N = 24) was composed of those who had postoperative SFC that is resolved spontaneously. Group II (N = 40) was composed of those who had postoperative SFC that is changed into internal hydrocephalus. Group III (N = 33) was composed of those who had postoperative hydrocephalus. Comparison among the three groups was done in the aspect of age, initial clinical grade, and initial CT grade. RESULTS: Group II or group III had larger proportion of patients over 60 years of age than group I, although the difference among the three groups was statistically not significant (p=0.98). Compared to group I, group II had larger proportion of patients whose initial Hunt and Hess grade (HHG) were 3 and 4 (p=0.005), and group II had larger proportion of patients whose initial Fisher grade (FG) was 3 (p<0.001) CONCLUSION: SFC following surgery for a ruptured aneurysm is mostly resolved spontaneously. In the cases of hydrocephalus, ventriculo-peritoneal (V-P) shunt should be performed. However, older patients and patients with Fisher grade 3 or poor clinical grade (HHG 3 and 4) may have a chance that SFC could change to internal hydrocephalus. We carefully suggest that they would be considered to undergo the shunt operation such as V-P shunt or double shunt (V-P and subduro-peritoneal shunt). KEYWORDS: SAH, Craniotomy, Subdural flui