Dengler Nora F, Diesing Dominik, Sarrafzadeh Asita, Wolf Stefan, Vajkoczy Peter
Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany.
Department of Neurosurgery, Universitätsklinikum Heidelberg, Heidelberg, Germany.
Neurosurgery. 2017 Aug 1;81(2):341-349. doi: 10.1093/neuros/nyw141.
In 2012, a new computed tomography (CT) grading scale was introduced by the Barrow Neurological Institute group ("BNI scale") to predict angiographic and symptomatic vasospasm in aneurysmal subarachnoid hemorrhage.
To address the question of whether BNI grading is reliable in the prediction of cerebral infarction and clinical outcome and to compare BNI scores to existing radiographic and clinical models of outcome prediction.
Consecutive data of 260 patients with aneurysmal subarachnoid hemorrhage was retrospectively analyzed with respect to radiographic and clinical parameters.
Patients presenting with more severe BNI grades were older ( P = .002), displayed lower Glasgow Coma Scale scores at admission ( P < .001) and were more often diagnosed with intraventricular hemorrhage ( P < .001). An increasing BNI grade was associated with higher rates of severe angiographic vasospasm ( P = .007), the occurrence of new cerebral infarction ( P < .001), and poor patient outcome ( P < .001). In contrast, analysis according to the Fisher grading system did not show a significant relationship to any outcome parameter. Multivariate analysis combining radiographic and clinical parameters showed significant results for clinical scores (Hunt and Hess and World Federation of Neurosurgical Societies) with radiographic information losing its predictive capability.
The BNI scale is easily applicable and superior to the original Fisher scale regarding prediction of angiographic vasospasm, new cerebral infarction, and patient outcome. Presence of intraventricular hemorrhage and intracerebral hemorrhage are additional radiographic factors with outcome relevance that are not part of the BNI scale. Established clinical scores like World Federation of Neurosurgical Societies and Hunt and Hess grading were more relevant for outcome prediction than any radiographic information.
2012年，巴罗神经学研究所团队引入了一种新的计算机断层扫描（CT）分级量表（“BNI量表”），用于预测动脉瘤性蛛网膜下腔出血患者的血管造影和症状性血管痉挛。
探讨BNI分级在预测脑梗死和临床结局方面是否可靠，并将BNI评分与现有的结局预测影像学和临床模型进行比较。
回顾性分析260例动脉瘤性蛛网膜下腔出血患者的影像学和临床参数的连续数据。
BNI分级较高的患者年龄较大（P = 0.002），入院时格拉斯哥昏迷量表评分较低（P < 0.001），且更常被诊断为脑室内出血（P < 0.001）。BNI分级增加与严重血管造影性血管痉挛发生率较高（P = 0.007）、新发性脑梗死的发生（P < 0.001）以及患者预后不良（P < 0.001）相关。相比之下，根据Fisher分级系统进行的分析未显示与任何结局参数有显著关系。结合影像学和临床参数的多变量分析显示，临床评分（Hunt和Hess以及世界神经外科协会联合会）有显著结果，而影像学信息失去了其预测能力。
BNI量表易于应用，在预测血管造影性血管痉挛、新发性脑梗死和患者结局方面优于原始的Fisher量表。脑室内出血和脑实质内出血的存在是与结局相关的额外影像学因素，它们不是BNI量表的一部分。像世界神经外科协会联合会以及Hunt和Hess分级这样的既定临床评分在结局预测方面比任何影像学信息都更相关。
