Intraventricular Hemorrhage Burden and Treatment-Specific Symptomatic Vasospasm After Aneurysmal Subarachnoid Hemorrhage

Figures

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  Figure 1. Patient selection flowchart. Of the 365 patients with aneurysmal SAH treated at Hanyang University Guri Hospital (January 2015–December 2025), 58 were excluded, leaving 307 patients (clipping, n = 224; coiling, n = 83) for analysis. Abbreviations: SAH, subarachnoid hemorrhage.

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  Figure 2. Comparison of hemorrhage burden and symptomatic vasospasm between the clipping and coiling groups. (A) Distribution of modified Fisher grades by treatment group. (B) Violin plots of the IVH Graeb score comparisons between treatment groups; circles and error bars represent medians and interquartile ranges. (C) Distribution of IVH Graeb score categories by treatment group. (D) Symptomatic vasospasm rates between treatment groups, shown for the total cohort and stratified by modified Fisher grade. The p-values were calculated using the chi-square test ((A,D) total cohort), Mann–Whitney U test (B), or Fisher’s exact test (C,D). Abbreviations: IVH, intraventricular hemorrhage.

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  Figure 3. Association between IVH Graeb score and symptomatic vasospasm in the clipping and coiling groups. (A) IVH Graeb score distributions stratified by symptomatic vasospasm status within each treatment group; circles and error bars represent medians and interquartile ranges. (B) Receiver operating characteristic curves for the predicted symptomatic vasospasm using the IVH Graeb score, shown separately for the clipping, coiling, and total cohorts. (C) Comparison of symptomatic vasospasm rates between the clipping and coiling groups by IVH Graeb score category across all modified Fisher grades (n = 307). (D) Comparison of symptomatic vasospasm rates between the clipping and coiling groups by IVH Graeb score category in patients with modified Fisher grade 4 only (n = 168). The p-values were calculated using the Mann–Whitney U test (A) or Fisher’s exact test (C,D). Abbreviations: AUC, area under the curve; IVH, intraventricular hemorrhage.

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  Figure 4. Multivariate logistic regression and subgroup analyses for symptomatic vasospasm. (A) Forest plot for the multivariate logistic regression analysis of the adjusted odds ratios for clinical predictors of symptomatic vasospasm in the total cohort (n = 307). (B) Subgroup analysis of the odds of symptomatic vasospasm for coiling versus clipping by IVH Graeb score category in all patients (n = 307). (C) Subgroup analysis restricted to patients with modified Fisher grade 4 (n = 168). Abbreviations: CI, confidence interval; CSF, cerebrospinal fluid; EVD, external ventricular drain; IVH, intraventricular hemorrhage; OR, odds ratio.