Unlocking the Battle-Clipping vs. Endovascular Therapy for Shunt-Dependent Hydrocephalus After Aneurysm Rupture: An In-Depth Institutional Analysis.

Vikas Chandra Jha, Rahul Jain, Vivek Saran Sinha, Nitish Kumar
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Abstract

Aim: To compare microsurgical clipping and endovascular therapy (EVT) for the management of shunt-dependent hydrocephalus (SDH) in patients with subarachnoid hemorrhage (SAH) and hydrocephalus.

Material and methods: This retrospective study was conducted from July 2018 to December 2022 and included 67 patients with SAH accompanied by acute hydrocephalus. Patients' demographic, clinical, and radiological data, such as age, sex, Glasgow Coma Scale scores, Hunt and Hess scale, Fischer grade, external ventricular drain (EVD) duration, complications, Ommaya reservoir placement, cerebrospinal fluid drainage, and outcomes, were obtained. Statistical analyses, including univariate analysis and stepwise logistic regression, revealed significant risk factors for shunt dependence.

Results: Of the 67 patients, 33 underwent microsurgical clipping and 34 received EVT. Spasmolysis reduced shunt dependency, whereas early EVD placement correlated with reduced shunt dependence (p=0.002). The Ommaya reservoir helped in the management of meningitis but was found to be associated with shunt dependency (p=0.04). Multiple logistic regression analysis revealed that perioperative infarct was a significant risk factor for shunt dependence (p=0.05). No significant difference in patient outcomes was observed between the two treatment groups. However, patients who received EVT had shorter intensive care unit and hospital stays.

Conclusion: This study shows that managing clinical vasospasm with spasmolysis may reduce shunt dependency. Overall, both microsurgical clipping and EVT offer similar long-term outcomes and efficacy in preventing shunt dependence, but the latter has the advantage of shorter hospital stay. These findings provide crucial insights for clinical decision-making and patient care in SDH after SAH.

揭开战幕:动脉瘤破裂后顺行依赖性脑积水的夹闭与血管内治疗--深入的机构分析。
目的:蛛网膜下腔出血(SAH)通常会导致分流依赖性脑积水(SDH)。本研究比较了显微外科剪切术和血管内治疗(EVT)治疗SAH脑积水患者的SDH:2018年7月至2022年12月进行的一项回顾性研究纳入了67例SAH急性脑积水患者。收集了人口统计学、临床和放射学参数的数据,如年龄、性别、GCS 评分、Hunt 和 Hess 分级、Fischer 评分、EVD 持续时间、并发症、Omaya 储库置入、CSF 引流和结果。包括单变量分析和逐步逻辑回归在内的统计分析确定了分流依赖的重要风险因素:67名患者中,33人接受了显微外科剪切术,34人接受了EVT。痉挛溶解降低了分流依赖性,而早期 EVD 置入与分流依赖性降低相关(p = 0.002)。Omaya 储库有助于控制脑膜炎,但与分流依赖性有关(p = 0.04)。通过多重逻辑回归分析,围手术期梗死是分流依赖性的一个重要风险因素(p = 0.05)。两组患者的预后无明显差异。然而,EVT 患者的重症监护室和住院时间更短:本研究强调,通过痉挛溶解治疗临床血管痉挛可减少分流的依赖性。总体而言,显微外科剪除术和EVT在预防分流依赖性方面的长期效果和疗效相似,但EVT的优势在于住院时间更短。这些发现为 SAH 后 SDH 的临床决策和患者护理提供了重要启示。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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