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

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.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.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; <i>p</i> < 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.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.