Departments of Neurological Surgery, Mount Sinai Hospital, New York, New York 10032, USA.
Neurosurg Focus. 2012 Apr;32(4):E5. doi: 10.3171/2012.2.FOCUS11372.
Intracerebral hemorrhage (ICH) is frequently complicated by acute hydrocephalus, necessitating emergency CSF diversion with a subset of patients, ultimately requiring long-term treatment via placement of permanent ventricular shunts. It is unclear what factors may predict the need for ventricular shunt placement in this patient population.
The authors performed a retrospective analysis of a prospective database (ICH Outcomes Project) containing patients with nontraumatic ICH admitted to the neurological ICU at Columbia University Medical Center between January 2009 and September 2011. A multiple logistic regression model was developed to identify independent predictors of shunt-dependent hydrocephalus after ICH. The following variables were included: patient age, admission Glasgow Coma Scale score, temporal horn diameter on admission CT imaging, bicaudate index, admission ICH volume and location, intraventricular hemorrhage volume, Graeb score, LeRoux score, third or fourth ventricle hemorrhage, and intracranial pressure (ICP) and ventriculitis during hospital stay.
Of 210 patients prospectively enrolled in the ICH Outcomes Project, 64 required emergency CSF diversion via placement of an external ventricular drain and were included in the final cohort. Thirteen of these patients underwent permanent ventricular CSF shunting prior to discharge. In univariate analysis, only thalamic hemorrhage and elevated ICP were significantly associated with the requirement for permanent CSF diversion, with p values of 0.008 and 0.033, respectively. Each remained significant in a multiple logistic regression model in which both variables were present.
Of patients with ICH requiring emergency CSF diversion, those with persistently elevated ICP and thalamic location of their hemorrhage are at increased odds of developing persistent hydrocephalus, necessitating permanent ventricular shunt placement. These factors may assist in predicting which patients will require permanent CSF diversion and could ultimately lead to improvements in the management of this disorder and the outcome in patients with ICH.
脑出血（ICH）常并发急性脑积水，需要对部分患者进行紧急脑脊液分流，最终需要通过永久性脑室分流来长期治疗。目前尚不清楚哪些因素可能预测该患者人群需要脑室分流。
作者对哥伦比亚大学医学中心神经重症监护病房 2009 年 1 月至 2011 年 9 月收治的非创伤性 ICH 患者前瞻性数据库（ICH 结局项目）进行了回顾性分析。建立了多因素逻辑回归模型，以确定 ICH 后需要依赖分流的脑积水的独立预测因素。纳入的变量包括：患者年龄、入院格拉斯哥昏迷评分、入院 CT 成像时的侧脑室体部直径、双尾指数、入院 ICH 量和部位、脑室内出血量、Graeb 评分、LeRoux 评分、第三或第四脑室出血、以及住院期间颅内压（ICP）和脑室炎。
在 ICH 结局项目中前瞻性纳入的 210 例患者中，64 例因急性脑积水需要紧急 CSF 引流，并纳入最终队列。其中 13 例患者在出院前接受了永久性脑室 CSF 分流。在单因素分析中，仅丘脑出血和 ICP 升高与永久性 CSF 分流的需求显著相关，p 值分别为 0.008 和 0.033。在多因素逻辑回归模型中，当两个变量均存在时，这两个变量仍然具有统计学意义。
在需要紧急 CSF 引流的 ICH 患者中，那些 ICP 持续升高且出血位于丘脑的患者发生持续性脑积水的几率增加，需要永久性脑室分流。这些因素可能有助于预测哪些患者需要永久性 CSF 分流，并最终改善该疾病的管理和 ICH 患者的预后。
