Chan Michael, Alaraj Ali, Calderon Mateo, Herrera Sebastian Ramon, Gao Weihua, Ruland Sean, Roitberg Ben Zion
Department of Neurosurgery, University of Illinois at Chicago, Illinois, USA.
J Neurosurg. 2009 Jan;110(1):44-9. doi: 10.3171/2008.5.17560.
Patients with subarachnoid hemorrhage treated using external ventricular drainage due to obstructive hydrocephalus commonly remain shunt-dependent. Based on identified risk factors for external ventricular drain (EVD) challenge failure, the authors sought to determine the likelihood that a patient will require a permanent shunt.
The authors reviewed 89 consecutive cases of aneurysmal subarachnoid hemorrhage with obstructive hydrocephalus for parameters associated with EVD challenge failure and permanent shunt requirement. Significant parameters were combined in a discriminant function analysis to create a failure risk index (FRI). Linear regression analysis was performed correlating the FRI with the actual rate of shunt dependency.
Patients requiring a permanent shunt had: a larger third ventricular diameter (7.0 vs 5.4 mm; p = 0.02) and a higher Hunt and Hess grade (3 vs 2; p = 0.02) at the time of admission; and a larger third ventricular diameter (6.6 vs 5.2 mm; p = 0.04), a larger bicaudate diameter (31.9 vs 30.2 mm; p = 0.03), and higher CSF protein levels (76.5 vs 40.3 mg/dl; p < 0.0001) at the onset of EVD challenge. These patients were also more likely to be female (p = 0.01) and have a posterior circulation location of their aneurysm (p = 0.01). The FRI score was calculated based on a weighted combination of the above parameters. Linear regression analysis between FRI values and the percentage of patients who required a permanent shunt had a correlation coefficient of 91%; the risk of a permanent shunt requirement increased linearly with a rising FRI score.
An FRI score created by discriminant function analysis can predict whether or not a permanent shunt is required, even if separate factors are not in agreement with each other or show a weak correlation when considered separately. An increased FRI score was strongly and linearly correlated with the risk of EVD challenge failure. A prospective study is necessary to validate the FRI.
因梗阻性脑积水采用脑室外引流治疗的蛛网膜下腔出血患者通常仍需依赖分流术。基于已确定的脑室外引流（EVD）试验失败的风险因素，作者试图确定患者需要永久性分流术的可能性。
作者回顾了89例连续的伴有梗阻性脑积水的动脉瘤性蛛网膜下腔出血病例，以寻找与EVD试验失败和永久性分流术需求相关的参数。将显著参数纳入判别函数分析以创建失败风险指数（FRI）。进行线性回归分析，将FRI与实际的分流依赖率相关联。
需要永久性分流术的患者在入院时具有：更大的第三脑室直径（分别为7.0 vs 5.4 mm；p = 0.02）和更高的Hunt和Hess分级（分别为3 vs 2；p = 0.02）；在EVD试验开始时具有更大的第三脑室直径（分别为6.6 vs 5.2 mm；p = 0.04）、更大的双尾状核直径（分别为31.9 vs 30.2 mm；p = 0.03）以及更高的脑脊液蛋白水平（分别为76.5 vs 40.3 mg/dl；p < 0.0001）。这些患者也更可能为女性（p = 0.01）且动脉瘤位于后循环部位（p = 0.01）。FRI评分基于上述参数的加权组合计算得出。FRI值与需要永久性分流术的患者百分比之间的线性回归分析的相关系数为91%；永久性分流术需求的风险随FRI评分升高而呈线性增加。
通过判别函数分析创建的FRI评分可以预测是否需要永久性分流术，即使单独的因素彼此不一致或单独考虑时显示出弱相关性。FRI评分增加与EVD试验失败的风险呈强烈线性相关。需要进行前瞻性研究以验证FRI。
