Neurosurgeons from China review the latest literature from across the world to develop the consensus guidelines
BEIJING, June 13, 2023 /PRNewswire/ — Aneurysmal subarachnoid hemorrhage-related hydrocephalus (aSAH-H) is a clinical syndrome that leads to excessive accumulation of cerebrospinal fluid (CSF) and ventricle enlargement in the brain. aSAH-H is a complex pathophysiological syndrome, leadingto cognitive impairment and neurological damage. Acute hydrocephalus (less than 3 days of aSAH) can result in a fatal cerebral hernia, whereas chronic hydrocephalus (more than 3 days of aSAH) can adversely affect a patient’s quality of life.
Despite the complexity of this condition, there is a lack of diagnostic criteria and treatment protocol for aSAH-H, in China and abroad. Moreover, the lack of consensus among clinicians on the preferred treatment for aSAH-H calls for an urgent need for consistent standards.
Prof. Shuo Wang from the Department of Neurosurgery at Beijing Tiantan Hospital, Capital Medical University, recently led an expert group from China to review and compose a consensus on the management of aSAH-H, based on the latest literature. The study was published in volume 9 of the Chinese Neurosurgical Journal on March 20, 2023. Dr. Hua Lu from the Department of Interventional Neuroradiology at Jiangsu Province Hospital along with Prof. Wang are the corresponding authors of this study.
“Hydrocephalus is a common complication following aSAH and currently, the diagnosis and treatment of aSAH-H is clouded by a lack of clarity and inconsistency of standards. We wanted to make definite progress toward removing the ambiguity tied to its treatment,” explains Prof. Wang.
In terms of occurrence, the experts identified that aSAH-H is determined by the location of the aneurysm, intraventricular hemorrhage, and volume of the subarachnoid hemorrhage. Disturbances in CSF circulation drive the pathogenesis of aSAH-H, enlarge the ventricular system, and damage the brain’s white matter. The experts concluded that age, volume of subarachnoid hemorrhage, the location and size of aneurysms are risk factors related to the occurrence of aSAH-H.
The consensus states that the standard-of-care approach to diagnosis should include reviewing a patient’s history of aSAH-H, identifying its clinical manifestations, and a head computed tomography scan to detect abnormal enlargement of the ventricles.
Moreover, the consensus states that aSAH-H treatment should be aimed at releasing excessive intracranial pressure or addressing pathological changes to prevent further damage and loss of neurological function. This can include medications inhibiting CSF secretion or surgical interventions, such as CSF drainage, CSF shunt surgery, and CSF intracranial diversion.
Furthermore, the consensus guideline recommends external ventricular drainage and ensuring the safe removal of the CSF drainage tube in the case of acute hydrocephalus. A ventriculoperitoneal shunt is recommended for cases of chronic hydrocephalus. The effectiveness of a shunt procedure can be confirmed with a positive lumbar puncture preceding surgery.
Lastly, the consensus suggests measures to minimize postoperative complications. It recommends strict aseptic surgical procedures, anti-siphon and pressure-adjustable shunt catheters, monitoring of clinical manifestations, and use of imaging and laboratory examinations for management.
Evincing hope about this development, Prof. Wang says, “This expert consensus applies to adults, but it’s a good reference point for clinical diagnosis and treatment. Further research will certainly refine the process of aSAH-H diagnosis and treatment.”
Title of original paper:
Chinese expert consensus on the management of aneurysmal subarachnoid hemorrhage-
Chinese Neurosurgical Journal
SOURCE Chinese Neurosurgical Journal