Binz Daniel D, Toussaint L Gerard, Friedman Jonathan A
Departments of Surgery, Neuroscience and Experimental Therapeutics, Texas A&M Health Science Center College of Medicine, College Station, TX, USA.
Neurocrit Care. 2009;10(2):253-6. doi: 10.1007/s12028-009-9193-0. Epub 2009 Feb 18.
The reported intracerebral hemorrhage rate due to ventriculostomy placement varies widely. As studies emerge regarding alternative techniques of ventriculostomy placement, and placement by non-neurosurgeons, further definition of the true intracerebral hemorrhage rate associated with ventriculostomy is warranted. We performed a meta-analysis of the existing literature to further elucidate the incidence of intracerebral hemorrhage due to ventriculostomy.
We performed an extensive literature search using Ovid MEDLINE and PubMed for relevant studies published after 1970. Only studies with more than 25 ventriculostomy procedures were included. Data were extracted regarding number of hemorrhages, clinically significant hemorrhages, and the use of routine post-ventriculostomy CT scanning. We performed subgroup analyses based on the use of routine post-ventriculostomy CT scanning. Chi-squared test was used to determine statistical significance.
Overall, 102 hemorrhagic complications from 1,790 ventriculostomies were reported, a hemorrhage rate of 5.7%. Of the 102 hemorrhages, 11 were clinically significant (clinically significant hemorrhage rate = 0.61%). In studies that used routine post-placement CT scans, the hemorrhage rate was 10.06%, compared to a hemorrhage rate of 1.53% in studies in which routine CT scans were not performed (P < 0.001). Eight clinically significant hemorrhages (0.91%) were identified in the studies utilizing routine post-procedural CT scanning, compared to three clinically significant hemorrhages (0.33%) in studies without routine CT scans (P = 0.113).
The overall hemorrhage risk associated with ventriculostomy placement based on the existing literature is 5.7%. Clinically significant hemorrhage due to ventriculostomy is less than 1%. Modifications of technique that might reduce hemorrhage risk, and the utility of routine post-procedural CT scanning, merit further investigation.
据报道，脑室造瘘术导致的脑出血发生率差异很大。随着关于脑室造瘘术替代技术以及非神经外科医生进行脑室造瘘术的研究不断涌现，有必要进一步明确与脑室造瘘术相关的真正脑出血发生率。我们对现有文献进行了荟萃分析，以进一步阐明脑室造瘘术导致脑出血的发生率。
我们使用Ovid MEDLINE和PubMed对1970年后发表的相关研究进行了广泛的文献检索。仅纳入了脑室造瘘术超过25例的研究。提取了关于出血数量、具有临床意义的出血以及术后常规CT扫描使用情况的数据。我们根据术后常规CT扫描的使用情况进行了亚组分析。采用卡方检验确定统计学意义。
总体而言，1790例脑室造瘘术中报告了102例出血并发症，出血率为5.7%。在这102例出血中，11例具有临床意义（具有临床意义的出血率=0.61%）。在使用术后常规CT扫描的研究中，出血率为10.06%，而在未进行常规CT扫描的研究中，出血率为1.53%（P<0.001）。在采用术后常规CT扫描的研究中，发现8例具有临床意义的出血（0.91%），而在未进行常规CT扫描的研究中有3例具有临床意义的出血（0.33%）（P=0.113）。
根据现有文献，脑室造瘘术相关的总体出血风险为5.7%。脑室造瘘术导致的具有临床意义的出血少于1%。可能降低出血风险的技术改进以及术后常规CT扫描的效用值得进一步研究。
