动脉瘤性蛛网膜下腔出血并发慢性分流依赖性脑积水：发病率、危险因素、临床表型和结局。

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

World neurosurgery Pub Date : 2025-03-13 DOI:10.1016/j.wneu.2025.123806

Lydia Larsson , Fredrik Vedung , Johan Virhammar , Elisabeth Ronne-Engström , Anders Lewén , Per Enblad , Teodor Svedung Wettervik

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引用次数: 0

摘要

目的：主要目的是确定动脉瘤性蛛网膜下腔出血（aSAH）后慢性分流依赖性脑积水（SDHC）的发生率、危险因素、临床表型和对分流手术的反应。方法：在这项观察性单中心研究中，纳入了2008-2018年间在乌普萨拉大学医院治疗的849例aSAH患者。对人口学、损伤严重程度、治疗、慢性脑积水表现和结果等变量进行评估。结果：107例（13%）患者因SDHC接受分流治疗。在多因素logistic回归中，SDHC的危险因素为入院时较差的神经系统评分（WFNS）、较大的脑室（Evans' index）、需要插入外脑室引流管（EVD）、开颅减压术和脑膜炎并发症。鉴定出6种不同的SDHC表型；神经系统恢复障碍（55%），Hakim-Adams综合征（17%），高压症状（13%），EVD切除失败（8%），开颅减压术后脑外疝(DC；6%)，硬膜下水瘤（1%）。前一组、三组患者改良Rankin量表（mRS）均显著改善，主观症状缓解率达87-100%。后三组的mRS没有明显变化，但60-100%的患者术后主观缓解。结论：慢性SDHC是aSAH后常见的并发症，特别是在有严重原发性脑损伤、急性脑积水和治疗相关因素的患者中。该病表现出不同的临床表型，这可能影响治疗反应。认识到这些表型有助于优化患者选择和对分流手术结果的期望。

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Chronic, Shunt-Dependent Hydrocephalus in Aneurysmal Subarachnoid Hemorrhage: Incidence, Risk Factors, Clinical Phenotypes, and Outcome

Objective

The main aim was to determine the incidence, risk factors, clinical phenotypes, and response to shunt surgery in chronic, shunt-dependent hydrocephalus (SDHC) after aneurysmal subarachnoid hemorrhage (aSAH).

Methods

In this observational, single-center study, 849 aSAH patients treated at Uppsala University Hospital between 2008–2018 were included. Variables on demography, injury severity, treatments, chronic hydrocephalus presentation, and outcome were evaluated.

Results

In total, 107 (13%) patients were treated with a shunt due to SDHC. In multivariate logistic regressions, risk factors for SDHC were worse neurologic (World Federation of Neurosurgical Societies) grade, larger ventricles (Evans index) at admission, the need to insert an external ventricular drain (EVD), decompressive craniectomy, and complications with meningitis. Six different SDHC phenotypes were identified: impeded neurological recovery (55%), Hakim-Adams syndrome (17%), high-pressure symptoms (13%), failed EVD removal (8%), external brain herniation after decompressive craniectomy (DC; 6%), and subdural hygroma (1%). The former 3 groups significantly improved in modified Rankin Scale (mRS) and 87%–100% exhibited subjective symptomatic relief. There was no significant change in mRS for the latter 3 groups, but 60%–100% experienced some subjective relief postoperatively.

Conclusions

Chronic SDHC was a common complication after aSAH, particularly in patients with severe primary brain injury, acute hydrocephalus, and treatment-related factors. The condition presents with distinct clinical phenotypes, which may influence treatment response. Recognizing these phenotypes could aid in optimizing patient selection and expectations for shunt surgery outcomes.

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来源期刊

World neurosurgery CLINICAL NEUROLOGY-SURGERY

CiteScore

3.90

自引率

15.00%

发文量

1765

审稿时长

47 days

期刊介绍： World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS