Outcome of Fourth Ventricular Hemorrhage in Ruptured Brain Aneurysms: Impact of Active Blood Clearance and Delayed Cerebral Ischemia Prevention.

IF 3.9 2区医学 Q1 CLINICAL NEUROLOGY

Neurosurgery Pub Date : 2024-11-26 DOI:10.1227/neu.0000000000003284

Manou Overstijns, István Csók, Ralf Watzlawick, Christian Scheiwe, Peter Reinacher, Jürgen Beck, Amir El Rahal, Roland Roelz

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Abstract

Background and objectives: Blood in the fourth ventricle is associated with poor outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH). We investigated (1) the prognostic significance of the amount of blood in the fourth ventricle and (2) the influence of active blood clearance and delayed cerebral ischemia prevention (ABCD).

Methods: We reviewed 817 consecutive aSAH patients admitted between January 1, 2009, and December 31, 2022, assessing blood amount in the fourth ventricle using a fourth ventricular hemorrhage scale (FVH): grade 1 (no or minimal blood), grade 2 (partially filled), grade 3 (completely filled/cast), and grade 4 (ballooning). Incidence of poor outcomes was evaluated using multivariate analysis before and after the introduction of ABCD (October 2015). Subsequently, a 1:1 matched-pairs analysis compared outcomes specifically between patients who underwent ABCD and matched controls receiving standard care. Neurological outcomes were evaluated at 6 months (independent modified Rankin scale).

Results: Before ABCD, poor outcomes occurred in 31/41 FVH grade 3 patients (76%; odds ratio (OR) 4.4) and in 38/41 FVH grade 4 patients (93%; OR 29.1). After ABCD, the incidence of poor outcomes decreased to 23/40 in FVH grade 3 patients (58%; P = .043; OR 1.3) and 31/41 in FVH grade 4 patients (76%; P = .017; OR: 3.6). The matched-pairs analysis also showed improvement in poor outcomes for FVH grade 4 patients who underwent ABCD compared with standard care (64% vs 89%, P = .024), but not for FVH grade 1 to 3 patients. No increase in the incidence of ventriculitis was seen in patients receiving ABCD treatment (P = .836).

Conclusion: Ballooning fourth ventricular hemorrhage (grade 4 FVH) is a powerful predictor of poor outcomes after aSAH. With the introduction of ABCD, the prognosis of these patients improved considerably and 25% reached functional independence 6 months after aSAH.

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脑动脉瘤破裂后第四脑室出血的结局：主动清除血液和延迟预防脑缺血的影响。

背景和目的：第四脑室积血与动脉瘤性蛛网膜下腔出血（aSAH）患者的不良预后有关。我们研究了：(1) 第四脑室血量对预后的意义；(2) 积极清除血液和延迟预防脑缺血（ABCD）的影响：我们对2009年1月1日至2022年12月31日期间连续收治的817例aSAH患者进行了回顾性研究，采用第四脑室出血评分表（FVH）评估第四脑室的血量：1级（无血或血量极少）、2级（部分充盈）、3级（完全充盈/呈铸型）和4级（气球）。在 ABCD 推出前后（2015 年 10 月），采用多变量分析评估了不良预后的发生率。随后，通过 1:1 配对分析比较了接受 ABCD 的患者与接受标准护理的配对对照组的具体预后。在6个月时对神经功能结果进行评估（独立改良Rankin量表）：ABCD前，31/41的FVH 3级患者（76%；比值比（OR）4.4）和38/41的FVH 4级患者（93%；比值比29.1）出现不良预后。ABCD 后，FVH 3 级患者的不良预后发生率降至 23/40（58%；P = .043；OR 1.3），FVH 4 级患者的不良预后发生率降至 31/41（76%；P = .017；OR：3.6）。配对分析还显示，与标准治疗相比，接受ABCD治疗的FVH 4级患者的不良预后有所改善（64% vs 89%，P = .024），但FVH 1至3级患者的不良预后没有改善。接受ABCD治疗的患者脑室炎的发生率没有增加（P = .836）：结论：气囊性第四脑室出血（4 级 FVH）是预测急性脑梗死后不良预后的有力指标。结论：气囊性第四脑室出血（4 级 FVH）是急性脑梗死后不良预后的有力预测因素，随着 ABCD 的引入，这些患者的预后大大改善，25% 的患者在急性脑梗死 6 个月后达到了功能独立。

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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来源期刊

Neurosurgery 医学-临床神经学

CiteScore

8.20

自引率

6.20%

发文量

898

审稿时长

2-4 weeks

期刊介绍： Neurosurgery, the official journal of the Congress of Neurological Surgeons, publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology, and medicine. For professionals aware of the rapid pace of developments in the field, this journal is nothing short of indispensable as the most complete window on the contemporary field of neurosurgery. Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook.