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Objective Background Hydrocephalus is a recognized complication of aneurysmal subarachnoid hemorrhage (SAH).While its incidence and risk factors have been described,the strategies for prevention and treatment of hydrocephalus have not been well defined.Methods and results In this retrospective study,1245 patients with aneurysmal SAH treated using either surgical clip application or endovascular coil embolization were studied at our institution between July 2000 and October 2009.One hundred eighty patients underwent clip application and 365 had coil embolization.In those patients who underwent clip application of anterior circulation aneurysms,the lamina terminalis was systematically fenestrated.The occurrence of obstructive hydrocephalus in both treatment groups and acute and chronic communicating hydrocephalus was analyzed.A subgroup analysis of patients with good clinical grade ( World Federation of Neurosurgical Societies [ WFNS ]Grades Ⅰ -Ⅲ ) and better Fisher Grade ( 1-3 ) and of patients with Fisher Grade 4 hemorrhage was performed.Acute hydrocephalus was observed in 19％ of surgical cases and 46％ of endovascular ones.Shunt-dependent hydrocephalus occurred in 14％ of surgical cases and 19％ of endovascular cases.This difference did not reach statistical significance (P =0.53 ).Logistic regression models controlling for patient age,WFNS grade,Fisher grade,and acute hydrocephalus in patients with good clinical grade and better Fisher grade revealed no significant difference in the rate of shunt-dependent hydrocephalus in both therapy groups ( odds ratio [ OR ] 0.8,95％ confidence interval [ CI]0.2-2.65 ).Results of similar models indicated that among patients with intraventricular hemorrhage ( IVH),surgical clip application carried a lower risk of shunt-dependent hydrocephalus (OR 0.32,95％ CI 0.14-0.75 ) compared with that for endovascular embolization.Conclusion Shunt-dependent hydrocephalus was comparable in the two treatment groups,even in patients with better clinical and radiological grades on admission.Only patients in the endovascular therapy group who had experienced IVH showed a higher likelihood of shunt-dependent hydrocephalus.