Article Data

  • Views 1035
  • Dowloads 238


Open Access Special Issue

Hydrocephalus after aneurysmal subarachnoid hemorrhage: Epidemiology, Pathogenesis, Diagnosis, and Management

  • Yu-Chang Wang1,2,3,†
  • Xiao-Qiang Wang4,†
  • Chang-Wu Tan1,2,3
  • Chuan-Sen Wang1,2,3
  • Zhi Tang5
  • Zhi-Ping Zhang1,2,3
  • Jing-Ping Liu1,2,3
  • Ge-Lei Xiao1,2,3

1Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P. R. China

2Diagnosis and Treatment Center for Hydrocephalus, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P. R. China

3National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P. R. China

4Pediatric neurological disease center, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200092, P. R. China

5Department of Neurosurgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, P. R. China

DOI: 10.22514/sv.2021.021 Vol.17,Issue 4,July 2021 pp.4-17

Submitted: 02 January 2021 Accepted: 26 January 2021

Published: 08 July 2021

*Corresponding Author(s): Ge-Lei Xiao E-mail:

† These authors contributed equally.


Hydrocephalus is one of the most common complications of aneurysmal subarachnoid hemorrhage (aSAH), which seriously affects the quality of life and shortens the survival time of affected patients. By reviewing the recent studies on the risk factors of aSAH-associated hydrocephalus, we aimed to explicitly present the pathogenesis of acute and chronic hydrocephalus after aSAH and make a comprehensive list of the associated risk factors of aSAH-associated hydrocephalus and shunt-dependent hydrocephalus. It would help us to better explain the occurrence of hydrocephalus after aSAH, especially hydrocephalus caused by inflammation after bleeding. Many studies have recently suggested that high mobility group box 1 may be an early upstream promoter of inflammatory response after aSAH, which also provides important ideas for us to look for potential drug treatments. The surgery, such as external ventricular drain and lumbar drainage, is the most common and effective treatment. Yet, there are often complications, such as rebleeding and intracranial infection, and the optimal timing of intervention is controversial. Besides, this is also a systematic review of the recent advances in epidemiology, pathogenesis, diagnosis, and management of aSAH-associated hydrocephalus.


Aneurysmal subarachnoid hemorrhage; Hydrocephalus; Pathogenesis; Therapeutic development; Management

Cite and Share

Yu-Chang Wang,Xiao-Qiang Wang,Chang-Wu Tan,Chuan-Sen Wang,Zhi Tang,Zhi-Ping Zhang,Jing-Ping Liu,Ge-Lei Xiao. Hydrocephalus after aneurysmal subarachnoid hemorrhage: Epidemiology, Pathogenesis, Diagnosis, and Management. Signa Vitae. 2021. 17(4);4-17.


[1] Sarfo FS, Ovbiagele B, Matthew OA, Akpalu A, Wahab K, Obiako R, et al. Antecedent febrile illness and occurrence of stroke in West Africa: the SIREN study. Journal of the Neurological Sciences. 2020; 418: 117158.

[2] Connolly ES, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2012; 43: 1711-1737.

[3] Vinas Rios JM, Sanchez-Aguilar M, Kretschmer T, Heinen C, Medina Govea FA, Jose Juan S, et al. Predictors of hydrocephalus as a complication of non-traumatic subarachnoid hemorrhage: a retrospective observational cohort study in 107 patients. Patient Safety in Surgery. 2018; 12: 13.

[4] Wang Y, Lin Y, Chuang M, Lee T, Tsai N, Cheng B, et al. Predictors and outcomes of shunt-dependent hydrocephalus in patients with aneurysmal sub-arachnoid hemorrhage. BMC Surgery. 2012; 12: 12.

[5] Hao X, Wei D. The risk factors of shunt-dependent hydrocephalus after subarachnoid space hemorrhage of intracranial aneurysms. Medicine. 2019; 98: e15970.

[6] Spina S, Laws SM. Insights into the pathogenesis of normal-pressure hydrocephalus. Neurology. 2019; 92: 933-934.

[7] Ban VS, El Ahmadieh TY, Aoun SG, Plitt AR, Lyon KA, Eddleman C, et al. Prediction of outcomes for ruptured aneurysm surgery. Stroke. 2019; 50: 595-601.

[8] Kooijman E, Nijboer CH, van Velthoven CTJ, Mol W, Dijkhuizen RM, Kesecioglu J, et al. Long-term functional consequences and ongoing cerebral inflammation after subarachnoid hemorrhage in the rat. PLoS ONE. 2014; 9: e90584.

[9] Wang K, Tang S, Lee J, Jeng J, Lai D, Huang S, et al. Intrathecal lactate predicting hydrocephalus after aneurysmal subarachnoid hemorrhage. The Journal of Surgical Research. 2015; 199: 523-528.

[10] Xiong L, Sun L, Zhang Y, Peng J, Yan J, Liu X. Exosomes from bone marrow mesenchymal stem cells can alleviate early brain injury after subarachnoid hemorrhage through miRNA129-5p-HMGB1 pathway. Stem Cells and Development. 2020; 29: 212-221.

[11] Long C, Huang G, Du Q, Zhou L, Zhou J. The dynamic expression of aquaporins 1 and 4 in rats with hydrocephalus induced by subarachnoid haemorrhage. Folia Neuropathologica. 2019; 57: 182-195.

[12] Rizwan Siddiqui M, Attar F, Mohanty V, Kim KS, Shekhar Mayanil C, Tomita T. Erythropoietin-mediated activation of aquaporin-4 channel for the treatment of experimental hydrocephalus. Child’s Nervous System. 2018; 34: 2195-2202.

[13] Liu X, Rivera SC, Faes L, Ferrante di Ruffano L, Yau C, Keane PA, et al. Reporting guidelines for clinical trials evaluating artificial intelligence interventions are needed. Nature Medicine. 2019; 25: 1467-1468.

[14] Paisan GM, Ding D, Starke RM, Crowley RW, Liu KC. Shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage: predictors and long-term functional outcomes. Neurosurgery. 2018; 83: 393-402.

[15] Lenski M, Biczok A, Huge V, Forbrig R, Briegel J, Tonn J, et al. Role of cerebrospinal fluid markers for predicting shunt-dependent hydrocephalus in patients with subarachnoid hemorrhage and external ventricular drain placement. World Neurosurgery. 2019; 121: e535-e542.

[16] Steiner T, Juvela S, Unterberg A, Jung C, Forsting M, Rinkel G. European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovascular Diseases. 2013; 35: 93-112.

[17] Cho W, Kim JE, Park SQ, Ko JK, Kim D, Park JC, et al. Korean clinical practice guidelines for aneurysmal subarachnoid hemorrhage. Journal of Korean Neurosurgical Society. 2018; 61: 127-166.

[18] Capion T, Lilja-Cyron A, Bartek J, Jr., Forsse A, Logallo N, Juhler M, et al. Discontinuation of external ventricular drainage in patients with hydrocephalus following aneurysmal subarachnoid hemorrhage-a scandinavian multi-institutional survey. Acta Neurochirurgica. 2020; 162: 1363-1370.

[19] Chung DY, Leslie-Mazwi TM, Patel AB, Rordorf GA. Management of external ventricular drains after subarachnoid hemorrhage: a multi-institutional survey. Neurocritical Care. 2017; 26: 356-361.

[20] Chang SI, Tsai MD, Yen DH, Hsieh C. The clinical predictors of shunt-dependent hydrocephalus following aneurysmal subarachnoid hemorrhage. Turkish Neurosurgery. 2018; 28: 36-42.

[21] Gerner ST, Reichl J, Custal C, Brandner S, Eyüpoglu IY, Lücking H, et al. Long-term complications and influence on outcome in patients surviving spontaneous subarachnoid hemorrhage. Cerebrovascular Diseases. 2020; 49: 307-315.

[22] Delpirou Nouh C, Samkutty DG, Chandrashekhar S, Santucci JA, Ford L, Xu C, et al. Management of aneurysmal subarachnoid hemorrhage: variation in clinical practice and unmet need for follow-up among survivors–a single-center perspective. World Neurosurgery. 2020; 139: e608-e617.

[23] Boswell S, Thorell W, Gogela S, Lyden E, Surdell D. Angiogram-negative subarachnoid hemorrhage: outcomes data and review of the literature. Journal of Stroke and Cerebrovascular Diseases. 2013; 22: 750-757.

[24] Sprenker C, Patel J, Camporesi E, Vasan R, Van Loveren H, Chen H, et al. Medical and neurologic complications of the current management strat-egy of angiographically negative nontraumatic subarachnoid hemorrhage patients. Journal of Critical Care. 2015; 30: 216.e7-216.11.

[25] Konczalla J, Schmitz J, Kashefiolasl S, Senft C, Seifert V, Platz J. Non-aneurysmal subarachnoid hemorrhage in 173 patients: a prospective study of long-term outcome. European Journal of Neurology. 2015; 22: 1329-1336.

[26] Walcott BP, Stapleton CJ, Koch MJ, Ogilvy CS. Diffuse patterns of nona-neurysmal subarachnoid hemorrhage originating from the Basal cisterns have predictable vasospasm rates similar to aneurysmal subarachnoid hemorrhage. Journal of Stroke and Cerebrovascular Diseases. 2015; 24: 795- 801.

[27] Coelho LGBSA, Costa JMD, Silva EIPA. Non-aneurysmal spon-taneous subarachnoid hemorrhage: perimesencephalic versus non-perimesencephalic. Revista Brasileira De Terapia Intensiva. 2016; 28: 141- 146.

[28] Isaacs AM, Riva-Cambrin J, Yavin D, Hockley A, Pringsheim TM, Jette N, et al. Age-specific global epidemiology of hydrocephalus: systematic review, metanalysis and global birth surveillance. PLoS ONE. 2018; 13: e0204926.

[29] Garton T, Keep RF, Wilkinson DA, Strahle JM, Hua Y, Garton HJL, et al. Intraventricular hemorrhage: the role of blood components in secondary injury and hydrocephalus. Translational Stroke Research. 2016; 7: 447-451.

[30] O’Kelly CJ, Kulkarni AV, Austin PC, Urbach D, Wallace MC. Shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage: incidence, predictors, and revision rates. Journal of Neurosurgery. 2009; 111: 1029-1035.

[31] Kanev PM, Sheehan JM. Reflections on shunt infection. Pediatric Neurosurgery. 2003; 39: 285-290.

[32] Dewan MC, Rattani A, Mekary R, Glancz LJ, Yunusa I, Baticulon RE, et al. Global hydrocephalus epidemiology and incidence: systematic review and meta-analysis. Journal of Neurosurgery. 2018; 130: 1-15.

[33] Wessell AP, Kole MJ, Cannarsa G, Oliver J, Jindal G, Miller T, et al. A sustained systemic inflammatory response syndrome is associated with shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage. Journal of Neurosurgery. 2018; 130: 1-8.

[34] Yu H, Zhan R, Wen L, Shen J, Fan Z. The relationship between risk factors and prognostic factors in patients with shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage. The Journal of Craniofacial Surgery. 2014; 25: 902-906.

[35] Kim JH, Kim JH, Kang HI, Kim DR, Moon BG, Kim JS. Risk factors and preoperative risk scoring system for shunt-dependent hydrocephalus following aneurysmal subarachnoid hemorrhage. Journal of Korean Neurosurgical Society. 2019; 62: 643-648.

[36] Bae I, Yi H, Choi K, Chun H. Comparison of incidence and risk factors for shunt-dependent hydrocephalus in aneurysmal subarachnoid hemorrhage patients. Journal of Cerebrovascular and Endovascular Neurosurgery. 2014; 16: 78-84.

[37] Chan M, Alaraj A, Calderon M, Herrera SR, Gao W, Ruland S, et al. Prediction of ventriculoperitoneal shunt dependency in patients with aneurysmal subarachnoid hemorrhage. Journal of Neurosurgery. 2009; 110: 44-49.

[38] Wessell AP, Kole MJ, Cannarsa G, Oliver J, Jindal G, Miller T, et al. A sustained systemic inflammatory response syndrome is associated with shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage. Journal of Neurosurgery. 2019; 130: 1984-1991.

[39] Savarraj J, Parsha K, Hergenroeder G, Ahn S, Chang TR, Kim DH, et al. Early brain injury associated with systemic inflammation after subarachnoid hemorrhage. Neurocritical Care. 2018; 28: 203-211.

[40] Chen L, Zhang Q. Increased mean platelet volume is associated with poor outcome in patients with aneurysmal subarachnoid hemorrhage. World Neurosurgery. 2020; 137: e118-e125.

[41] Jabbarli R, Pierscianek D, RÖlz R, Reinhard M, Darkwah Oppong M, Scheiwe C, et al. Gradual external ventricular drainage weaning reduces the risk of shunt dependency after aneurysmal subarachnoid hemorrhage: a pooled analysis. Operative Neurosurgery. 2018; 15: 498-504.

[42] Nakatsuka Y, Kawakita F, Yasuda R, Umeda Y, Toma N, Sakaida H, et al. Preventive effects of cilostazol against the development of shunt-dependent hydrocephalus after subarachnoid hemorrhage. Journal of Neurosurgery. 2017; 127: 319-326.

[43] Han M, Won YD, Na MK, Kim CH, Kim JM, Ryu JI, et al. Association between possible osteoporosis and shunt-dependent hydrocephalus after subarachnoid hemorrhage. Stroke. 2018; 49: 1850-1858.

[44] Virta JJ, Satopää J, Luostarinen T, Raj R. One-year outcome after aneurysmal subarachnoid hemorrhage in elderly patients. World Neuro-surgery. 2020; 143: e334-e343.

[45] Diesing D, Wolf S, Sommerfeld J, Sarrafzadeh A, Vajkoczy P, Dengler NF. A novel score to predict shunt dependency after aneurysmal subarachnoid hemorrhage. Journal of Neurosurgery. 2018; 128: 1273-1279.

[46] García S, Torné R, Hoyos JA, Rodríguez-Hernández A, Amaro S, Llull L, et al. Quantitative versus qualitative blood amount assessment as a predictor for shunt-dependent hydrocephalus following aneurysmal subarachnoid hemorrhage. Journal of Neurosurgery. 2018; 131: 1743-1750.

[47] Adams H, Ban VS, Leinonen V, Aoun SG, Huttunen J, Saavalainen T, et al. Risk of shunting after aneurysmal subarachnoid hemorrhage: a collaborative study and initiation of a consortium. Stroke. 2016; 47: 2488-2496.

[48] Erixon HO, Sorteberg A, Sorteberg W, Eide PK. Predictors of shunt dependency after aneurysmal subarachnoid hemorrhage: results of a single-center clinical trial. Acta Neurochirurgica. 2014; 156: 2059-2069.

[49] Jeong TS, Yoo CJ, Kim WK, Yee GT, Kim EY, Kim MJ. Factors related to the development of shunt-dependent hydrocephalus following subarachnoid hemorrhage in the elderly. Turkish Neurosurgery. 2018; 28: 226-233.

[50] Mijderwijk H, Fischer I, Zhivotovskaya A, Bostelmann R, Steiger H, Cornelius JF, et al. Prognostic model for chronic shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage. World Neu-rosurgery. 2019; 124: e572-e579.

[51] Zaidi HA, Montoure A, Elhadi A, Nakaji P, McDougall CG, Albu-querque FC, et al. Long-term functional outcomes and predictors of shunt-dependent hydrocephalus after treatment of ruptured intracranial aneurysms in the BRAT trial: revisiting the clip vs coil debate. Neurosurgery. 2015; 76: 608-613.

[52] Chung DY, Olson DM, John S, Mohamed W, Kumar MA, Thompson BB, et al. Evidence-based management of external ventricular drains. Current Neurology and Neuroscience Reports. 2019; 19: 94.

[53] Gupta R, Ascanio LC, Enriquez-Marulanda A, Griessenauer CJ, Chin-nadurai A, Jhun R, et al. Validation of a predictive scoring system for ventriculoperitoneal shunt insertion after aneurysmal subarachnoid hemorrhage. World Neurosurgery. 2018; 109: e210-e216.

[54] Walcott BP, Iorgulescu JB, Stapleton CJ, Kamel H. Incidence, timing, and predictors of delayed shunting for hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurocritical Care. 2015; 23: 54-58.

[55] Hasan D, Vermeulen M, Wijdicks EF, Hijdra A, van Gijn J. Management problems in acute hydrocephalus after subarachnoid hemorrhage. Stroke. 1989; 20: 747-753.

[56] Park YK, Yi H, Choi K, Lee Y, Chun H, Kwon SM, et al. Predicting factors for shunt-dependent hydrocephalus in patients with aneurysmal subarachnoid hemorrhage. Acta Neurochirurgica. 2018; 160: 1407-1413.

[57] Chen S, Luo J, Reis C, Manaenko A, Zhang J. Hydrocephalus after subarachnoid hemorrhage: pathophysiology, diagnosis, and treatment. BioMed Research International. 2017; 2017: 8584753.

[58] Miller BA, Turan N, Chau M, Pradilla G. Inflammation, vasospasm, and brain injury after subarachnoid hemorrhage. BioMed Research International. 2014; 2014: 384342.

[59] Satomi J, Hadeishi H, Yoshida Y, Suzuki A, Nagahiro S. Histopatholog-ical findings in brains of patients who died in the acute stage of poor-grade subarachnoid hemorrhage. Neurologia Medico-Chirurgica. 2016; 56: 766-770.

[60] Klimo P, Kestle JRW, MacDonald JD, Schmidt RH. Marked reduction of cerebral vasospasm with lumbar drainage of cerebrospinal fluid after subarachnoid hemorrhage. Journal of Neurosurgery. 2004; 100: 215-224.

[61] Carare RO, Bernardes-Silva M, Newman TA, Page AM, Nicoll JAR, Perry VH, et al. Solutes, but not cells, drain from the brain parenchyma along basement membranes of capillaries and arteries: significance for cerebral amyloid angiopathy and neuroimmunology. Neuropathology and Applied Neurobiology. 2008; 34: 131-144.

[62] Golanov EV, Bovshik EI, Wong KK, Pautler RG, Foster CH, Federley RG, et al. Subarachnoid hemorrhage-induced block of cerebrospinal fluid flow: role of brain coagulation factor III (tissue factor). Journal of Cerebral Blood Flow and Metabolism. 2018; 38: 793-808.

[63] Close LN, Zanaty M, Kirby P, Dlouhy BJ. Acute hydrocephalus resulting from neuromyelitis optica: a case report and review of the literature. World Neurosurgery. 2019; 129: 367-371.

[64] Bloch O, Papadopoulos MC, Manley GT, Verkman AS. Aquaporin-4 gene deletion in mice increases focal edema associated with staphylococcal brain abscess. Journal of Neurochemistry. 2005; 95: 254-262.

[65] Lucke-Wold BP, Logsdon AF, Manoranjan B, Turner RC, McConnell E, Vates GE, et al. Aneurysmal subarachnoid hemorrhage and neuroin-flammation: a comprehensive review. International Journal of Molecular Sciences. 2016; 17: 497.

[66] de Oliveira Manoel AL, Macdonald RL. Neuroinflammation as a target for intervention in subarachnoid hemorrhage. Frontiers in Neurology. 2018; 9: 292.

[67] Macdonald RL, Marton LS, Andrus PK, Hall ED, Johns L, Sajdak M. Time course of production of hydroxyl free radical after subarachnoid hemorrhage in dogs. Life Sciences. 2004; 75: 979-989.

[68] Hua C, Zhao G. Biomarkers in adult posthemorrhagic hydrocephalus. International Journal of Stroke. 2017; 12: 574-579.

[69] Tombini M, Squitti R, Cacciapaglia F, Ventriglia M, Assenza G, Benvenga A, et al. Inflammation and iron metabolism in adult patients with epilepsy: does a link exist? Epilepsy Research. 2013; 107: 244-252.

[70] Mahaney KB, Buddhala C, Paturu M, Morales D, Limbrick DD, Strahle JM. Intraventricular hemorrhage clearance in human neonatal cerebrospinal fluid: associations with hydrocephalus. Stroke. 2020; 51: 1712-1719.

[71] Zhang Y, Zheng S, Shang-Guan H, Kang D, Chen G, Yao P. Lower iron levels predict acute hydrocephalus following aneurysmal subarachnoid hemorrhage. World Neurosurgery. 2019; 126: e907-e913.

[72] Sokół B, Woźniak A, Jankowski R, Jurga S, Wąsik N, Shahid H, et al. HMGB1 level in cerebrospinal fluid as a marker of treatment outcome in patients with acute hydrocephalus following aneurysmal subarachnoid hemorrhage. Journal of Stroke and Cerebrovascular Diseases. 2015; 24: 1897-1904.

[73] Sun Q, Wu W, Hu Y, Li H, Zhang D, Li S, et al. Early release of high-mobility group box 1 (HMGB1) from neurons in experimental subarach-noid hemorrhage in vivo and in vitro. Journal of Neuroinflammation. 2014; 11: 106.

[74] Macdonald RL, Schweizer TA. Spontaneous subarachnoid haemorrhage. The Lancet. 2017; 389: 655-666.

[75] Chaudhry SR, Hafez A, Rezai Jahromi B, Kinfe TM, Lamprecht A, Niemelä M, et al. Role of damage associated molecular pattern molecules (DAMPs) in aneurysmal subarachnoid hemorrhage (aSAH). International Journal of Molecular Sciences. 2018; 19: 2035.

[76] Muhammad S, Chaudhry SR, Kahlert UD, Lehecka M, Korja M, Niemelä M, et al. Targeting high mobility group box 1 in subarachnoid hemorrhage: a systematic review. International Journal of Molecular Sciences. 2020; 21: 2709.

[77] Balusu S, Van Wonterghem E, De Rycke R, Raemdonck K, Stremersch S, Gevaert K, et al. Identification of a novel mechanism of blood-brain communication during peripheral inflammation via choroid plexus-derived extracellular vesicles. EMBO Molecular Medicine. 2016; 8: 1162-1183.

[78] Karimy JK, Zhang J, Kurland DB, Theriault BC, Duran D, Stokum JA, et al. Inflammation-dependent cerebrospinal fluid hypersecretion by the choroid plexus epithelium in posthemorrhagic hydrocephalus. Nature Medicine. 2017; 23: 997-1003.

[79] Lv SY, Wu Q, Liu JP, Shao J, Wen LL, Xue J, et al. Levels of interleukin-1β, interleukin-18, and tumor necrosis factor-α in cerebrospinal fluid of aneurysmal subarachnoid hemorrhage patients may be predictors of early brain injury and clinical prognosis. World Neurosurg. 2018; 111: e362-e373.

[80] Chaudhry SR, Stoffel-Wagner B, Kinfe TM, Güresir E, Vatter H, Dietrich D, et al. Elevated systemic IL-6 levels in patients with aneurysmal subarachnoid hemorrhage is an unspecific marker for post-SAH complications. International Journal of Molecular Sciences. 2017; 18: 2580.

[81] Chaudhry SR, Güresir E, Vatter H, Kinfe TM, Dietrich D, Lamprecht A, et al. Aneurysmal subarachnoid hemorrhage lead to systemic upregulation of IL-23/IL-17 inflammatory axis. Cytokine. 2018; 97: 96-103.

[82] Wessell AP, Kole MJ, Cannarsa G, Oliver J, Jindal G, Miller T, et al. A sustained systemic inflammatory response syndrome is associated with shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage. Journal of Neurosurgery. 2018; 130: 1-8.

[83] Chaudhry SR, Kahlert UD, Kinfe TM, Lamprecht A, Niemelä M, Hänggi D, et al. Elevated systemic IL-10 levels indicate immunodepression lead-ing to nosocomial infections after aneurysmal subarachnoid hemorrhage (SAH) in patients. International Journal of Molecular Sciences. 2020; 21: 1569.

[84] Mittal SK, Cho K, Ishido S, Roche PA. Interleukin 10 (IL-10)-mediated immunosuppression: MARCH-i induction regulates antigen presentation by macrophages but not dendritic cells. The Journal of Biological Chemistry. 2015; 290: 27158-27167.

[85] Wang K, Tang S, Lee J, Li Y, Huang Y, Yang W, et al. Cerebrospinal fluid high mobility group box 1 is associated with neuronal death in subarachnoid hemorrhage. Journal of Cerebral Blood Flow and Metabolism. 2017; 37: 435-443.

[86] Zhan C, Xiao G, Zhang X, Chen X, Zhang Z, Liu J. Decreased MiR-30a promotes TGF-β1-mediated arachnoid fibrosis in post-hemorrhagic hydrocephalus. Translational Neuroscience. 2020; 11: 60-74.

[87] Shim JW, Sandlund J, Hameed MQ, Blazer-Yost B, Zhou FC, Klagsbrun M, et al. Excess HB-EGF, which promotes VEGF signaling, leads to hydrocephalus. Scientific Reports. 2016; 6: 26794.

[88] Chen W, Ten Dijke P. Immunoregulation by members of the TGFβ superfamily. Nature Reviews Immunology. 2016; 16: 723-740.

[89] Douglas MR, Daniel M, Lagord C, Akinwunmi J, Jackowski A, Cooper C, et al. High CSF transforming growth factor beta levels after subarachnoid haemorrhage: association with chronic communicating hydrocephalus. Journal of Neurology, Neurosurgery, and Psychiatry. 2009; 80: 545-550.

[90] Yan H, Chen Y, Li L, Jiang J, Wu G, Zuo Y, et al. Decorin alleviated chronic hydrocephalus via inhibiting TGF-β1/Smad/CTGF pathway after subarachnoid hemorrhage in rats. Brain Research. 2016; 1630: 241-253.

[91] Botfield H, Gonzalez AM, Abdullah O, Skjolding AD, Berry M, McAllister JP, et al. Decorin prevents the development of juvenile communicating hydrocephalus. Brain. 2013; 136: 2842-2858.

[92] Chen H, Chen L, Xie D, Niu J. Protective effects of transforming growth factor-β1 knockdown in human umbilical cord mesenchymal stem cells against subarachnoid hemorrhage in a rat model. Cerebrovascular Diseases. 2020; 49: 79-87.

[93] Tan Q, Chen Q, Feng Z, Shi X, Tang J, Tao Y, et al. Cannabinoid receptor 2 activation restricts fibrosis and alleviates hydrocephalus after intraventricular hemorrhage. Brain Research. 2017; 1654: 24-33.

[94] Shim JW, Madsen JR. VEGF signaling in neurological disorders. International Journal of Molecular Sciences. 2018; 19: 275.

[95] Asami A, Kurganov E, Miyata S. Proliferation of endothelial cells in the choroid plexus of normal and hydrocephalic mice. Journal of Chemical Neuroanatomy. 2020; 106: 101796.

[96] Reeson P, Tennant KA, Gerrow K, Wang J, Weiser Novak S, Thompson K, et al. Delayed inhibition of VEGF signaling after stroke attenuates blood-brain barrier breakdown and improves functional recovery in a comorbidity-dependent manner. Journal of Neuroscience. 2015; 35: 5128-5143.

[97] Naureen I, Waheed KAI, Rathore AW, Victor S, Mallucci C, Goodden JR, et al. Fingerprint changes in CSF composition associated with different aetiologies in human neonatal hydrocephalus: inflammatory cytokines. Child’s Nervous System. 2014; 30: 1155-1164.

[98] Yoshimura S, Morishita R, Hayashi K, Kokuzawa J, Aoki M, Matsumoto K, et al. Gene transfer of hepatocyte growth factor to subarachnoid space in cerebral hypoperfusion model. Hypertension. 2002; 39: 1028-1034.

[99] Feng Z, Liu S, Chen Q, Tan Q, Xian J, Feng H, et al. UPA alleviates kaolin-induced hydrocephalus by promoting the release and activation of hepatocyte growth factor in rats. Neuroscience Letters. 2020; 731: 135011.

[100] Gholampour S. FSI simulation of CSF hydrodynamic changes in a large population of non-communicating hydrocephalus patients during treatment process with regard to their clinical symptoms. PLoS ONE. 2018; 13: e0196216.

[101] Guillerman RP. Infant craniospinal ultrasonography: beyond hemor-rhage and hydrocephalus. Seminars in Ultrasound, CT, and MR. 2010; 31: 71-85.

[102] Eymann R. Clinical symptoms of hydrocephalus. Der Radiologe. 2012; 52: 807-812. (In German)

[103] Langner S, Fleck S, Baldauf J, Mensel B, Kühn JP, Kirsch M. Diagnosis and differential diagnosis of hydrocephalus in adults. Fortschritte Auf Dem Gebiete Der Rontgenstrahlen Und Der Nuklearmedizin. 2017; 189: 728- 739.

[104] Kartal MG, Ocakoglu G, Algin O. Feasibility of 3-dimensional sampling perfection with application optimized contrast sequence in the evaluation of patients with hydrocephalus. Journal of Computer Assisted Tomography. 2015; 39: 321-328.

[105] Relkin N, Marmarou A, Klinge P, Bergsneider M, Black PM. Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery. 2005; 57: S4-S16.

[106] Kartal MG, Algin O. Evaluation of hydrocephalus and other cere-brospinal fluid disorders with MRI: an update. Insights into Imaging. 2014; 5: 531-541.

[107] Beaumont TL, Limbrick DD, Rich KM, Wippold FJ, Dacey RG. Natural history of colloid cysts of the third ventricle. Journal of Neurosurgery. 2016; 125: 1420-1430.

[108] Langner S, Buelow R, Fleck S, Angermaier A, Kirsch M. Management of intracranial incidental findings on brain MRI. Fortschritte Auf Dem Gebiete Der Rontgenstrahlen Und Der Nuklearmedizin. 2016; 188: 1123-1133.

[109] Jaraj D, Rabiei K, Marlow T, Jensen C, Skoog I, Wikkelsø C. Estimated ventricle size using Evans index: reference values from a population-based sample. European Journal of Neurology. 2017; 24: 468-474.

[110] Missori P, Rughetti A, Peschillo S, Gualdi G, Di Biasi C, Nofroni I, et al. In normal aging ventricular system never attains pathological values of Evans’ index. Oncotarget. 2016; 7: 11860-11863.

[111] Brix MK, Westman E, Simmons A, Ringstad GA, Eide PK, Wagner-Larsen K, et al. The Evans’ index revisited: new cut-off levels for use in radiological assessment of ventricular enlargement in the elderly. European Journal of Radiology. 2017; 95: 28-32.

[112] Gunes A, Oncel IH, Gunes SO, Birbilen AZ, Hanalioglu S. Use of computed tomography and diffusion weighted imaging in children with ventricular shunt. Child’s Nervous System. 2019; 35: 477-486.

[113] Ohana O, Soffer S, Zimlichman E, Klang E. Overuse of CT and MRI in paediatric emergency departments. The British Journal of Radiology. 2018; 91: 20170434.

[114] Narayan AK, Tekes A, Greene A, Mahesh M, Jackson EM, Huisman TAGM, et al. Radiation dose reduction in children with hydrocephalus using ultrafast brain MRI. Journal of the American College of Radiology. 2019; 16: 1173-1176.

[115] Marchese RF, Schwartz ES, Heuer GG, Lavelle J, Huh JW, Bell LM, et al. Reduced radiation in children presenting to the ed with suspected ventricular shunt complication. Pediatrics. 2017; 139: e20162431.

[116] Wymer DT, Patel KP, Burke WF, Bhatia VK. Phase-contrast MRI: physics, techniques, and clinical applications. RadioGraphics. 2020; 40: 122- 140.

[117] Bradley WG, Kortman KE, Burgoyne B. Flowing cerebrospinal fluid in normal and hydrocephalic states: appearance on MR images. Radiology. 1986; 159: 611-616.

[118] Bargalló N, Olondo L, Garcia AI, Capurro S, Caral L, Rumia J. Functional analysis of third ventriculostomy patency by quantification of CSF stroke volume by using cine phase-contrast MR imaging. American Journal of Neuroradiology. 2005; 26: 2514-2521.

[119] Hosny A, Parmar C, Quackenbush J, Schwartz LH, Aerts HJWL. Artificial intelligence in radiology. Nature Reviews Cancer. 2018; 18: 500- 510.

[120] Ibrahim GM, Macdonald RL. The network topology of aneurysmal subarachnoid haemorrhage. Journal of Neurology, Neurosurgery & Psychiatry. 2015; 86: 895-901.

[121] Duan W, Zhang J, Zhang L, Lin Z, Chen Y, Hao X, et al. Evaluation of an artificial intelligent hydrocephalus diagnosis model based on transfer learning. Medicine. 2020; 99: e21229.

[122] Russakovsky O, Deng J, Su H, Krause J, Satheesh S, Ma S, et al. ImageNet large scale visual recognition challenge. International Journal of Computer Vision. 2015; 115: 211-252.

[123] Komura D, Ishikawa S. Machine learning approaches for pathologic diagnosis. Virchows Archiv. 2019; 475: 131-138.

[124] Klimont M, Flieger M, Rzeszutek J, Stachera J, Zakrzewska A, Jończyk-Potoczna K. Automated ventricular system segmentation in paediatric patients treated for hydrocephalus using deep learning methods. BioMed Research International. 2019; 2019: 3059170.

[125] Rasmussen MK, Mestre H, Nedergaard M. The glymphatic pathway in neurological disorders. The Lancet Neurology. 2018; 17: 1016-1024.

[126] Gao F, Zheng M, Hua Y, Keep RF, Xi G. Acetazolamide attenuates thrombin-induced hydrocephalus. Acta Neurochirurgica Supplement. 2016; 121: 373-377.

[127] Owler BK, Pitham T, Wang D. Aquaporins: relevance to cerebrospinal fluid physiology and therapeutic potential in hydrocephalus. Cere-brospinal Fluid Research. 2010; 7: 15.

[128] Trillo-Contreras JL, Ramírez-Lorca R, Hiraldo-González L, Sánchez-Gomar I, Galán-Cobo A, Suárez-Luna N, et al. Combined effects of aquaporin-4 and hypoxia produce age-related hydrocephalus. Biochimica et Biophysica Acta Molecular Basis of Disease. 2018; 1864: 3515-3526.

[129] Carrion E, Hertzog JH, Medlock MD, Hauser GJ, Dalton HJ. Use of acetazolamide to decrease cerebrospinal fluid production in chronically ventilated patients with ventriculopleural shunts. Archives of Disease in Childhood. 2001; 84: 68-71.

[130] McCarthy KD, Reed DJ. The effect of acetazolamide and furosemide on cerebrospinal fluid production and choroid plexus carbonic anhydrase activity. The Journal of Pharmacology and Experimental Therapeutics. 1974; 189: 194-201.

[131] Uldall M, Botfield H, Jansen-Olesen I, Sinclair A, Jensen R. Acetazo-lamide lowers intracranial pressure and modulates the cerebrospinal fluid secretion pathway in healthy rats. Neuroscience Letters. 2017; 645: 33-39.

[132] Bin K, Shi-Peng Z. Acetazolamide inhibits aquaporin-1 expression and colon cancer xenograft tumor growth. Hepato-Gastroenterology. 2011; 58: 1502-1506.

[133] Abir-Awan M, Kitchen P, Salman MM, Conner MT, Conner AC, Bill RM. Inhibitors of mammalian aquaporin water channels. International Journal of Molecular Sciences. 2019; 20: 1589.

[134] Libenson MH, Kaye EM, Rosman NP, Gilmore HE. Acetazolamide and furosemide for posthemorrhagic hydrocephalus of the newborn. Pediatric Neurology. 1999; 20: 185-191.

[135] Kennedy CR, Ayers S, Campbell MJ, Elbourne D, Hope P, Johnson A. Randomized, controlled trial of acetazolamide and furosemide in posthemorrhagic ventricular dilation in infancy: follow-up at 1 year. Pediatrics. 2001; 108: 597-607.

[136] International randomised controlled trial of acetazolamide and furosemide in posthaemorrhagic ventricular dilatation in infancy. International PHVD Drug Trial Group. Lancet. 1998; 352: 433-440.

[137] Mazzola CA, Choudhri AF, Auguste KI, Limbrick DD, Rogido M, Mitchell L, et al. Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 2: management of posthemorrhagic hydrocephalus in premature infants. Journal of Neurosurgery. 2014; 14: 8- 23.

[138] Suryaningtyas W, Arifin M, Rantam FA, Bajamal AH, Dahlan YP, Dewa Gede Ugrasena I, et al. Erythropoietin protects the subventricular zone and inhibits reactive astrogliosis in kaolin-induced hydrocephalic rats. Child’s Nervous System. 2019; 35: 469-476.

[139] Sporrborn JL, Knudsen GB, Sølling M, Seierøe K, Farre A, Lindhardt BØ, et al. Brain ventricular dimensions and relationship to outcome in adult patients with bacterial meningitis. BMC Infectious Diseases. 2015; 15: 367.

[140] Thwaites GE, Macmullen-Price J, Chau TTH, Phuong Mai P, Dung NT, Simmons CP, et al. Serial MRI to determine the effect of dexamethasone on the cerebral pathology of tuberculous meningitis: an observational study. The Lancet Neurology. 2007; 6: 230-236.

[141] Shah I, Meshram L. High dose versus low dose steroids in children with tuberculous meningitis. Journal of Clinical Neuroscience. 2014; 21: 761-764.

[142] Toma N, Imanaka-Yoshida K, Takeuchi T, Matsushima S, Iwata H, Yoshida T, et al. Tenascin-C-coated platinum coils for acceleration of organization of cavities and reduction of lumen size in a rat aneurysm model. Journal of Neurosurgery. 2005; 103: 681-686.

[143] Sajanti J, Heikkinen E, Majamaa K. Rapid induction of meningeal collagen synthesis in the cerebral cisternal and ventricular compartments after subarachnoid hemorrhage. Acta Neurochirurgica. 2008; 104: 179-182.

[144] Cho O, Jang Y, Park K, Heo T. Beneficial anti-inflammatory effects of combined rosuvastatin and cilostazol in a TNF-driven inflammatory model. Pharmacological Reports. 2019; 71: 266-271.

[145] Yeh P, Huang Y, Chang S, Wang L, Yang C, Yang W, et al. Cilostazol attenuates retinal oxidative stress and inflammation in a streptozotocin-induced diabetic animal model. Current Eye Research. 2019; 44: 294-302.

[146] Melo JRT, Di Rocco F, Bourgeois M, Puget S, Blauwblomme T, Sainte-Rose C, et al. Surgical options for treatment of traumatic subdural hematomas in children younger than 2 years of age. Journal of Neurosurgery: Pediatrics. 2014; 13: 456-461.

[147] Ilic I, Schuss P, Borger V, Hadjiathanasiou A, Vatter H, Fimmers R, et al. Ventriculostomy with subsequent ventriculoperitoneal shunt placement after subarachnoid hemorrhage: the effect of implantation site on postoperative complications-a single-center series. Acta Neurochirurgica. 2020; 162: 1831-1836.

[148] Bjornson A, Tapply I, Nabbanja E, Lalou A, Czosnyka M, Czosnyka Z, et al. Ventriculo-peritoneal shunting is a safe and effective treatment for idiopathic intracranial hypertension. British Journal of Neurosurgery. 2019; 33: 62-70.

[149] Mallucci CL, Jenkinson MD, Conroy EJ, Hartley JC, Brown M, Dalton J, et al. Antibiotic or silver versus standard ventriculoperitoneal shunts (BASICS): a multicentre, single-blinded, randomised trial and economic evaluation. Lancet. 2019; 394: 1530-1539.

[150] Zhu X. The hemorrhage risk of prophylactic external ventricular drain insertion in aneurysmal subarachnoid hemorrhage patients requiring endovascular aneurysm treatment: a systematic review and meta-analysis. Journal of Neurosurgical Sciences. 2017; 61: 53-63.

[151] Liang C, Yang L, Guo S. Serial lumbar puncture reduces cerebrospinal fluid (CSF) infection during removal of hemorrhagic CSF in aneurysmal subarachnoid hemorrhage after endovascular coiling. The Journal of Biomedical Research. 2018; 32: 305-310.

[152] Tan C, Wang X, Wang Y, Wang C, Tang Z, Zhang Z, et al. The pathogenesis based on the glymphatic system, diagnosis, and treatment of idiopathic normal pressure hydrocephalus. Clinical Interventions in Aging. 2021; 16: 139-153.

[153] Alqaim M, Cosar E, Crawford AS, Robichaud DI, Walz JM, Schanzer A, et al. Lumbar drain complications in patients undergoing fenestrated or branched endovascular aortic aneurysm repair: development of an institutional protocol for lumbar drain management. Journal of Vascular Surgery. 2020; 72: 1576-1583.

[154] Souweidane MM. Endoscopic management of pediatric brain tumors. Neurosurgical Focus. 2005; 18: E1.

[155] O’Brien DF, Hayhurst C, Pizer B, Mallucci CL. Outcomes in patients undergoing single-trajectory endoscopic third ventriculostomy and endoscopic biopsy for midline tumors presenting with obstructive hydrocephalus. Journal of Neurosurgery. 2006; 105: 219-226.

[156] Etus V, Ceylan S. Success of endoscopic third ventriculostomy in children less than 2 years of age. Neurosurgical Review. 2005; 28: 284-288.

[157] Ascanio LC, Gupta R, Adeeb N, Moore JM, Griessenauer CJ, Mayeku J, et al. Relationship between external ventricular drain clamp trials and ventriculoperitoneal shunt insertion following nontraumatic subarach-noid hemorrhage: a single-center study. Journal of Neurosurgery. 2018; 130: 956-962.

[158] Akinduro OO, Vivas-Buitrago TG, Haranhalli N, Ganaha S, Mbabuike N, Turnbull MT, et al. Predictors of ventriculoperitoneal shunting following subarachnoid hemorrhage treated with external ventricular drainage. Neurocritical Care. 2020; 32: 755-764.

[159] Kamenova M, Croci D, Guzman R, Mariani L, Soleman J. Low-dose acetylsalicylic acid and bleeding risks with ventriculoperitoneal shunt placement. Neurosurgical Focus. 2016; 41: E4.

[160] Wajd NA-H, Thomas JW, Zarina SA, Ryan PB, Kelly JB, Tannaz G, et al. Gastrostomy tube placement increases the risk of ventriculoperitoneal shunt infection: a multiinstitutional study. Journal of Neurosurgery. 2018; 131: 1-6.

[161] Zhang Y, Zhu X, Zhao J, Hou K, Gao X, Sun Y, et al. Ventriculoperi-toneal shunting surgery with open distal shunt catheter placement in the treatment of hydrocephalus. Cell Biochemistry and Biophysics. 2015; 73: 533- 536.

[162] Rumalla K, Smith KA, Arnold PM, Mittal MK. Subarachnoid hemor-rhage and readmissions: national rates, causes, risk factors, and outcomes in 16,001 hospitalized patients. World Neurosurgery. 2018; 110: e100-e111.

[163] Dasenbrock HH, Smith TR, Rudy RF, Gormley WB, Aziz-Sultan MA, Du R. Reoperation and readmission after clipping of an unruptured intracranial aneurysm: a National Surgical Quality Improvement Program analysis. Journal of Neurosurgery. 2018; 128: 756-767.

[164] Dasenbrock HH, Angriman F, Smith TR, Gormley WB, Frerichs KU, Aziz-Sultan MA, et al. Readmission after aneurysmal subarachnoid hemorrhage: a nationwide readmission database analysis. Stroke. 2017; 48: 2383-2390.

[165] Wang Y, Gao Y, Lu M, Liu Y. Long-term functional prognosis of patients with aneurysmal subarachnoid hemorrhage treated with rehabilitation combined with hyperbaric oxygen: case-series study. Medicine. 2020; 99: e18748.

[166] Bateman RM, Sharpe MD, Jagger JE, Ellis CG, Solé-Violán J, López-Rodríguez M, et al. 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016. Critical Care. 2016; 20: 94.

[167] Karic T, Røe C, Nordenmark TH, Becker F, Sorteberg W, Sorteberg A. Effect of early mobilization and rehabilitation on complications in aneurysmal subarachnoid hemorrhage. Journal of Neurosurgery. 2017; 126: 518-526.

[168] Juvela S, Kaste M, Hillbom M. The effects of earlier surgery and shorter bedrest on the outcome in patients with subarachnoid haemorrhage. Journal of Neurology, Neurosurgery, and Psychiatry. 1989; 52: 776-777.

[169] Reijmer YD, van den Heerik MS, Heinen R, Leemans A, Hendrikse J, de Vis JB, et al. Microstructural white matter abnormalities and cognitive impairment after aneurysmal subarachnoid hemorrhage. Stroke. 2018; 49: 2040-2045.

[170] Lorber J. Isosorbide in the medical treatment of infantile hydrocephalus. Journal of Neurosurgery. 1973; 39: 702-711.

[171] Lackner P, Beer R, Broessner G, Helbok R, Galiano K, Pleifer C, et al. Efficacy of silver nanoparticles-impregnated external ventricular drain catheters in patients with acute occlusive hydrocephalus. Neurocritical Care. 2008; 8: 360-365.

[172] Tuettenberg J, Czabanka M, Horn P, Woitzik J, Barth M, Thomé C, et al. Clinical evaluation of the safety and efficacy of lumbar cerebrospinal fluid drainage for the treatment of refractory increased intracranial pressure. Journal of Neurosurgery. 2009; 110: 1200-1208.

[173] Sufianov AA, Sufianova GZ, Iakimov IA. Endoscopic third ventricu-lostomy in patients younger than 2 years: outcome analysis of 41 hydrocephalus cases. Journal of Neurosurgery. Pediatrics. 2010; 5: 392-401.

[174] Murad A, Ghostine S, Colohan ART. Role of controlled lumbar CSF drainage for ICP control in aneurysmal SAH. Acta Neurochirurgica. 2011; 110: 183-187.

[175] Pinto FC, Saad F, Oliveira MF, Pereira RM, Miranda FL, Tornai JB, et al. Role of endoscopic third ventriculostomy and ventriculoperitoneal shunt in idiopathic normal pressure hydrocephalus: preliminary results of a randomized clinical trial. Neurosurgery. 2013; 72: 845-853; discussion 853- 844.

[176] Sun C, Du H, Yin L, He M, Tian Y, Li H. Choice for the removal of bloody cerebrospinal fluid in postcoiling aneurysmal subarachnoid hemorrhage: external ventricular drainage or lumbar drainage? Turkish Neurosurgery. 2014; 24: 737-744.

[177] Kulkarni AV, Riva-Cambrin J, Rozzelle CJ, Naftel RP, Alvey JS, Reeder RW, et al. Endoscopic third ventriculostomy and choroid plexus cauterization in infant hydrocephalus: a prospective study by the Hydrocephalus Clinical Research Network. Journal of Neurosurgery Pediatrics. 2018; 21: 214-223.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 0.5(2019) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time