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J Neurol Surg A Cent Eur Neurosurg
DOI: 10.1055/a-2568-4732
Original Article

Cerebral Hemorrhage Volume Threshold and Shunt-Dependent Acute Hydrocephalus in Aneurysmal Subarachnoid Hemorrhage: A Semiautomated Measurement Study

Gema Bravo-Garrido 
1   Department of Neurosurgery, Torrecardenas University Hospital, Almeria, Andalucía, Spain
,
Antonio José Vargas-Lopez
1   Department of Neurosurgery, Torrecardenas University Hospital, Almeria, Andalucía, Spain
,
Miriam Fernández-Gómez
2   Department of Interventional Neuroradiology, Torrecardenas University Hospital, Almeria, Andalucía, Spain
,
Mario Gomar-Alba
1   Department of Neurosurgery, Torrecardenas University Hospital, Almeria, Andalucía, Spain
,
Gaizka Urreta-Juárez
1   Department of Neurosurgery, Torrecardenas University Hospital, Almeria, Andalucía, Spain
,
Patricia Martínez-Sánchez
3   Department of Neurology, Torrecardenas University Hospital, Almeria, Andalucía, Spain
› Author Affiliations
Funding None.
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Abstract

Background

Hydrocephalus is a common complication of aneurysmal subarachnoid hemorrhage (aSAH) that can adversely affect prognosis. This study investigates the association between semiautomatic measurement of cerebral hemorrhage volumes in aSAH patients and the onset of shunt-dependent acute hydrocephalus (SDAHC) within the first 72 hours. Furthermore, the study seeks to establish a bleeding volume threshold indicative of SDAHC.

Methods

A retrospective observational analysis was conducted on a cohort of aSAH patients admitted to a specialized referral hospital between 2016 and 2021. Volumes of SAH, intraventricular hemorrhage (IVH), intraparenchymal hemorrhage (IPH), and total hemorrhage (TH) were computed from brain computed tomography scans utilizing Advantage Workstation Server analytical software. Receiver operating characteristic (ROC) curves and multivariate analyses were employed to determine the association between hemorrhage volumes and SDAHC.

Results

The study included 170 patients, of whom 111 (65.3%) were women, with a mean age of 58.5 years (standard deviation: 14.6). Fifty-five patients (32.4%) presented SDAHC. IVH volumes had an area under the ROC curve of 0.757 (95% confidence interval [CI]: 0.674–0.839; p < 0.001). An IVH volume > 2.7 cm3 showed a sensitivity of 70.9% and a specificity of 77.2% for predicting SDAHC, whereas TH volumes > 29.5 cm3 demonstrated a sensitivity of 69.1% and a specificity of 61.4%. Multivariate analysis revealed that IVH volumes > 2.7 cm3 (odds ratio [OR]: 5.373; 95% CI: 2.477–11.657), TH volumes > 29.5 cm3 (OR: 2.232; 95% CI: 1.008–4.942), and a bicaudate index ≥ 0.2 were significantly associated with SDAHC, adjusting for confounders.

Conclusions

In aSAH patients, semiautomatic measurement of hemorrhage volumes using specialized software is independently associated with SDAHC. This method could facilitate early prediction and timely intervention.

Keywords

aneurysmal subarachnoid hemorrhage - semiautomated hemorrhage volumetric analysis - shunt-dependent acute hydrocephalus

Ethical Approval

The study protocol has been approved by the Clinical Research Ethics Committee. All personal data obtained in this study are confidential and have been used exclusively for the specific purposes of this study. This study has been conducted in accordance with the principles of good clinical practice and following international and national regulations governing biomedical research, especially the Declaration of Helsinki, Law 14/2007 of July 3 on Biomedical Research, as well as Regulation (EU) 2016/679 of the European Parliament and of the Council of April 27, 2016, and Law 3/2018 of December 5 on Personal Data Protection and guarantee of digital rights.


Availability of Data and Materials

The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request. All materials used in the study are fully accessible to ensure reproducibility of the results.




Publication History

Received: 02 November 2024

Accepted: 27 March 2025

Accepted Manuscript online:
28 March 2025

Article published online:
01 July 2025

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