gms | German Medical Science

Objective: Only few data exist concerning development of chronic hydrocephalus (CH) in patients beyond their sixth decade of life after acute subarachnoid hemorrhage (SAH). CH in the elderly is postulated to be due to a decreased ventricular compliance, wider subarachnoid space resulting in larger volumes of subarachnoid blood collection and an increased leptomeningeal fibrosis leading to impairment of cerebrospinal fluid (CSF) circulation with decreased secretion and absoprtion of CSF. The goal of our study was to investigate the impact of age and to identify other possible risk factors leading to the development of chronic hydrocephalus after acute SAH as predictors for shunt dependency in elderly patients.

Method: We investigated 1005 patients with acute SAH due to ruptured intracranial aneurysms who were either treated microsurgically or with coilembolization. Patients were classified by age into two groups. Group I included 359 patients beyond 60 years (range 60-88, mean 67.86) and group II with 646 patients under 60 years of age (range 11-59, mean 44.87).

Results: In group I 69 patients (19.3%) developed CH and were treated with a shunt. In group II 76 patients (11.8%) became shunt dependent. Thus, there was a significant correlation of the shunt dependency and the patient's age over 60 years (Fisher's exact test p=0.0019).

Conclusions: Our large clinical series proves a significant correlation of CH and patient's age over sixty years. Besides anatomical and pathophysiological variants of the elderly brain, Hunt and Hess grade, intraventricular hemorrhage, acute hydrocephalus on admission and site of the ruptured aneurysm seem to be important predictors of the rate of chronic hydrocephalus. Further studies are needed to foresee the necessity for shunting in elderly patients after acute SAH in order to ensure an early and adequate treatment.