2017 年 45 巻 3 号 p. 189-195
Secondary normal-pressure hydrocephalus (sNPH) following subarachnoid hemorrhage (SAH) is known to be related with poor outcome. Neurosurgeons have tried several treatments and procedures for prevention of sNPH, but none of them was proven to be effective. We chronologically reviewed 20 articles that described the risk for the development of sNPH associated with microsurgical clipping and endovascular coil embolization as treatments for ruptured aneurysms. Among 17,042 patients with SAH caused by ruptured cerebral aneurysms registered in 20 articles, 2,527 patients (14.8%) were diagnosed as having sNPH. sNPH was diagnosed in 1,673 (15.2%) of 10, 986 patients treated with microsurgical clipping and in 854 (14.1%) of 6,056 patients treated with coil embolization. The odds ratio (95% confidential interval) for the development of sNPH among the patients treated with clipping was 1.09 (1.00-1.20) in comparison with that among the patients treated with coil embolization (probability value of a Fisher exact test, 0.048). Before 2012, compared with clipping, coil embolization was associated with a higher incidence for the development of sNPH. After 2012, however, clipping was associated with a higher incidence of sNPH than coil embolization. Recently, the techniques and devices used in coil embolization have remarkably progressed, and their indication has expanded. Therefore, the background of patients treated with coil embolization is similar to that of patients treated with microsurgical clipping. Large studies that directly compare between clipping and coil embolization are needed to elucidate their real effect on the risk of developing sNPH.
