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目的：分析比较Hunt-Hess Ⅲ～Ⅳ级动脉瘤性蛛网膜下腔出血（aSAH）患者血管介入栓塞与开颅夹闭手术后并发急性脑积水的差异及预后。方法回顾性分析武警后勤学院附属医院和武警总医院2011年1月至2014年7月接受血管介入栓塞（介入栓塞组，403例）或开颅夹闭手术（开颅夹闭组，364例）的Hunt-Hess Ⅲ～Ⅳ级aSAH患者的临床资料，筛选出术后出现急性脑积水的病例，运用统计学方法对可能造成两组术后脑积水形成差异的因素进行量化与赋值，通过出院时格拉斯哥预后评分（GOS）判断脑积水患者短期预后情况，比较两种手术的优缺点。结果介入栓塞组403例患者中术后出现脑积水56例（13.90%），开颅夹闭组364例患者中术后出现脑积水33例（9.07%），两组脑积水发生率差异有统计学意义（χ2＝4.350， P＝0.037）。767例aSAH患者中，行血肿清除者脑积水发生率显著低于未行血肿清除者〔3.07%（11/358）比19.07%（78/409），χ2＝47.635，P＝0.000〕；行脑室引流者脑积水发生率显著低于未行脑室引流者〔2.77%（19/685）比85.37%（70/82），χ2＝487.032，P＝0.000〕。在介入栓塞组403例患者中，行血肿清除者脑积水发生率略低于未行血肿清除者〔8.06%（5/62）比14.96%（51/341），χ2＝2.082，P＝0.168〕；行脑室引流者脑积水发生率显著低于未行脑室引流者〔2.59%（9/347）比83.93%（47/56），χ2＝266.599，P＝0.000〕。在开颅夹闭组364例患者中，行血肿清除者脑积水发生率显著低于未行血肿清除者〔2.03%（6/296）比39.71%（27/68），χ2＝95.226，P＝0.000〕；行脑室引流者脑积水发生率显著低于未行脑室引流者〔2.96%（10/338）比88.46%（23/26），χ2＝203.852，P＝0.000〕。介入栓塞组与开颅夹闭组之间行血肿清除者脑积水发生率差异有统计学意义〔8.06%（5/62）比2.03%（6/296），χ2＝4.411，P＝0.027〕；而行脑室引流者脑积水发生率差异无统计学意义〔2.59%（9/347）比2.96%（10/338），χ2＝0.085，P＝0.819〕。56例行介入栓塞术后出现脑积水的患者，出院时预后良好（GOS评分4～5分）23例（41.07%），预后不良（GOS评分1～3分）33例（58.93%）；33例行开颅夹闭手术后出现脑积水的患者，出院时预后良好（GOS评分4～5分）21例（63.64%），预后不良（GOS评分1～3分）12例（36.36%），两组预后差异有统计学意义（χ2＝4.230，P＝0.039）。结论血肿清除是造成Hunt-HessⅢ～Ⅳ级患者血管介入栓塞和开颅夹闭手术后脑积水差异形成的主要因素之一；侧脑室引流可能不是造成Hunt-HessⅢ～Ⅳ级患者血管介入栓塞和开颅夹闭手术术后脑积水差异形成的因素；患者开颅夹闭手术短期预后优于血管介入栓塞治疗。“,”ObjectiveTo analyze and compare the difference and prognosis between vascular embolization and craniotomy occlusion in patients suffering from aneurysmal subarachnoid hemorrhage (aSAH) with Hunt-Hess levelⅢ-Ⅳ, and acute postoperative hydrocephalus.Methods A retrospective study was conducted on 767 patients who had undergone vascular embolization (vascular embolization group,n = 403) or craniotomy occlusion operation (craniotomy occlusion operation group,n = 364), and the patients with postoperative acute hydrocephalus were screened. The clinical data of patients of both groups was analyzed. By judging short-term prognosis in patients with hydrocephalus with Glasgow outcome scale (GOS) score estimated at discharge, the advantages and disadvantages of two surgical procedures were compared.Results The number of cases with postoperative hydrocephalus in vascular embolization group was 56 (13.90%), while that in craniotomy occlusion group was 33 (9.07%). The difference between the two groups of incidence of hydrocephalus was statistically significant (χ2= 4.350,P = 0.037 ). In 767 patients with aSAH, the incidence of hydrocephalus among the patients after the hematoma removal operation was significantly lower than that of patients without hematoma removal [3.07% (11/358) vs. 19.07% (78/409),χ2 = 47.635,P = 0.000]. The incidence of hydrocephalus among the patients after ventricular drainage was significantly lower than that of patients without the drainage [2.77% (19/685) vs. 85.37% (70/82),χ2 = 487.032,P = 0.000]. In 403 cases of vascular embolization group, the incidence of hydrocephalus in the patients after the hematoma removal operation was lower than that of patients without it [8.06% (5/62) vs. 14.96% (51/341),χ2 = 2.082,P = 0.168]. The incidence of hydrocephalus in the patients after the ventricular drainage was lower than that of patients without drainage [2.59% (9/347) vs. 83.93% (47/56),χ2 = 266.599,P = 0.000]. In 364 cases of craniotomy occlusion operation group, the incidence of hydrocephalus in the patients after hematoma removal operation was significantly lower than that of patients did not receive [2.03% (6/296) vs. 39.71% (27/68),χ2 = 95.226,P = 0.000]. The incidence of hydrocephalus among the patients after the ventricular drainage was significantly lower than that of patients without drainage [2.96% (10/338) vs. 88.46% (23/26),χ2 = 203.852,P = 0.000]. The difference in incidence of hydrocephalus between the patients who had hematoma removal surgery between vascular embolization group and craniotomy occlusion operation group was statistically significant [8.06% (5/62) vs. 2.03% (6/296),χ2 = 4.411,P = 0.027], while no statistically difference was present in ventricular drainage patients [2.59% (9/347) vs. 2.96% (10/338),χ2 = 0.085,P = 0.819]. There were 23 patients (41.07%) with good outcome (GOS score 4-5), while 33 (58.93%) with poor outcome (GOS score 1-3) in 56 patients undergone vascular embolization operation. Good result (GOS score 4-5) was shown in 21 (63.64%) and 12 (36.36%) with poor outcome (GOS score 1-3) among 33 patients with hydrocephalus after craniotomy occlusion operation, and the difference was statistically significant (χ2 = 4.230,P = 0.039).Conclusions Hematoma is one of the main factor contributing to the differences in the incidence of postoperative hydrocephalus of Hunt-Hess gradeⅢ-Ⅳ patients either receiving vascular embolization or craniotomy occlusion operation. Lateral ventricle drainage may not be the factor that contributes to the difference in incidence of hydrocephalus formation between the vascular embolization and craniotomy occlusion operation groups in Hunt-Hess levelⅢ-Ⅳ patients. The short term prognosis in the craniotomy occlusion operation group is superior to that of endovascular intervention embolization group.