Pinggera Daniel, Kerschbaumer Johannes, Petr Ondra, Ortler Martin, Thomé Claudius, Freyschlag Christian F
Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria.
Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria.
World Neurosurg. 2017 Dec;108:107-111. doi: 10.1016/j.wneu.2017.08.129. Epub 2017 Sep 1.
Hydrocephalus is a common sequelae of aneurysmal subarachnoid hemorrhage (aSAH). However, in daily routine it is difficult to predict a patient's need for ventricular shunt placement in the course of the disease.
The purpose of this study was to identify radiologic predictors for development of a shunt-dependent hydrocephalus after aSAH.
A cohort of 217 patients with aSAH with adequate pretreatment computed tomography (CT) imaging was retrospectively reviewed. All variables, including demographic data, treatment, and initial CT imaging were gathered and grading was performed using Hunt and Hess, Graeb, LeRoux, and modified Fisher scores. Analysis of the radiographic parameters consisted of straight measurement and three-dimensional volumetry using manual segmentation. Univariate and multivariate statistical analyses were performed to identify predictive parameters.
Of 217 patients, 36 (17.5%) required a ventricular shunt (VS). A receiver operating characteristic analysis between the volume of the third ventricle and shunt-dependent hydrocephalus showed a significant cutoff at a volume of 2.3 cm with a 4.3-fold higher risk for shunt dependency (P < 0.001). However, the treatment modality and classification according to the mentioned scores were not associated with the need for VS after aSAH. In univariate and multivariate analysis, the volume of the third ventricle on admission remained a significant prognostic marker for the need of a VS.
Our data suggest that the volume of the third ventricle in the initial CT is a strong predictor for shunt dependency after aSAH.
脑积水是动脉瘤性蛛网膜下腔出血（aSAH）的常见后遗症。然而，在日常临床工作中，很难预测患者在疾病过程中是否需要进行脑室分流术。
本研究旨在确定aSAH后发生分流依赖性脑积水的影像学预测指标。
回顾性分析217例aSAH患者，这些患者术前均有合适的计算机断层扫描（CT）影像资料。收集所有变量，包括人口统计学数据、治疗情况和初始CT影像资料，并使用Hunt和Hess、Graeb、LeRoux以及改良Fisher评分进行分级。影像学参数分析包括使用手动分割进行直线测量和三维容积测量。进行单因素和多因素统计分析以确定预测参数。
217例患者中，36例（17.5%）需要进行脑室分流术（VS）。第三脑室容积与分流依赖性脑积水之间的受试者工作特征分析显示，当容积为2.3 cm时存在显著临界值，分流依赖性风险高出4.3倍（P < 0.001）。然而，根据上述评分的治疗方式和分类与aSAH后是否需要VS无关。在单因素和多因素分析中，入院时第三脑室容积仍然是需要进行VS的重要预后指标。
我们的数据表明，初始CT检查时第三脑室的容积是aSAH后分流依赖性的有力预测指标。
