Department of Neurological Surgery, University of Florida, Gainesville, Florida, USA.
World Neurosurg. 2011 Dec;76(6):548-54. doi: 10.1016/j.wneu.2011.05.054.
Few studies have compared the incidence of ventricular shunt placement for hydrocephalus after clipping versus coiling of cerebral aneurysms.
The Nationwide Inpatient Sample (NIS) database was used to compare, on a national level, the incidence of ventricular shunt placement after clipping versus coiling of ruptured and unruptured aneurysms.
Hospitalizations for clipping and coiling of ruptured and unruptured aneurysms from 2002 to 2007 were collected from the NIS by cross-matching International Classification of Diseases-9 codes for diagnoses of subarachnoid hemorrhage or unruptured cerebral aneurysm with procedure codes for clipping or coiling. The incidence of ventricular shunt placement for hydrocephalus after clipping and coiling was compared using generalized linear models with generalized estimating equations (GEE) to adjust for patient- and hospital-specific factors and correlation between admissions.
Of 10,899 ruptured aneurysm patients (6593 clipping, 4306 coiling), clipping had a similar incidence of ventricular shunt placement (9.3%) compared to coiling (10.5%) (odds ratio = 0.984; 95% confidence interval = 0.85, -1.14; P value = 0.833 after adjustment for patient-specific and hospital-specific factors). Likewise, of 9686 unruptured aneurysm patients (4483 clipping, 5203 coiling), clipping had similar incidence of ventricular shunt placement (0.4%) compared to coiling (0.5%) (odds ratio = 0.763; 95% confidence interval = 0.37, -1.58; P value = 0.465 after adjustment for patient-specific and hospital-specific factors). Predictors of shunt placement in ruptured aneurysm patients were age, comorbidity score, admission type, payer, and hospital aneurysm volume. Predictors of shunt placement in unruptured aneurysm patients were comorbidity score and admission type.
In an observational study, clipping and coiling of ruptured and unruptured cerebral aneurysms are associated with similar incidences of ventricular shunt placement for hydrocephalus.
很少有研究比较夹闭和栓塞治疗脑动脉瘤后发生脑积水行脑室分流术的发生率。
利用国家住院患者样本（NIS）数据库，在全国范围内比较夹闭和栓塞治疗破裂和未破裂脑动脉瘤后行脑室分流术的发生率。
通过国际疾病分类第 9 版诊断亚急性蛛网膜下腔出血或未破裂脑动脉瘤的代码与夹闭或栓塞术的程序代码交叉匹配，从 NIS 中收集 2002 年至 2007 年夹闭和栓塞治疗破裂和未破裂脑动脉瘤的住院患者资料。使用广义线性模型和广义估计方程（GEE）比较夹闭和栓塞治疗后发生脑积水行脑室分流术的发生率，以调整患者和医院特定因素以及住院患者之间的相关性。
在 10899 例破裂性脑动脉瘤患者中（夹闭 6593 例，栓塞 4306 例），夹闭组发生脑室分流术的比例（9.3%）与栓塞组（10.5%）相似（比值比=0.984；95%置信区间=0.85，-1.14；P 值=0.833，在调整患者和医院特定因素后）。同样，在 9686 例未破裂性脑动脉瘤患者中（夹闭 4483 例，栓塞 5203 例），夹闭组发生脑室分流术的比例（0.4%）与栓塞组（0.5%）相似（比值比=0.763；95%置信区间=0.37，-1.58；P 值=0.465，在调整患者和医院特定因素后）。破裂性脑动脉瘤患者发生分流术的预测因素为年龄、合并症评分、入院类型、支付方和医院动脉瘤体积。未破裂性脑动脉瘤患者发生分流术的预测因素为合并症评分和入院类型。
在一项观察性研究中，夹闭和栓塞治疗破裂和未破裂脑动脉瘤后发生脑积水行脑室分流术的发生率相似。
