立体定向脑室外引流术清除蛛网膜下腔出血：一项匹配队列研究。
Stereotactic Catheter Ventriculocisternostomy for Clearance of Subarachnoid Hemorrhage: A Matched Cohort Study.
机构信息
From the Department of Neurosurgery (R.R., C.S., I.C.), Department of Stereotactic and Functional Neurosurgery (V.A.C., P.C.R.), Department of Neurology (W.-D.N.), Department of Neuroradiology (K.E., H.U.), and Department of Nursing-IT (R.K.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; and Department of Neurosurgery, University Hospital Essen, Germany (R.J.).
出版信息
Stroke. 2017 Oct;48(10):2704-2709. doi: 10.1161/STROKEAHA.117.018397. Epub 2017 Sep 13.
BACKGROUND AND PURPOSE
Delayed cerebral infarction (DCI) is a major source of morbidity and mortality after aneurysmal subarachnoid hemorrhage. We report a novel intervention-stereotactic catheter ventriculocisternostomy (STX-VCS) and fibrinolytic/spasmolytic lavage therapy-for DCI prevention. Outcomes of 20 consecutive patients are compared with 60 matched controls.
METHODS
On the basis of individual treatment decisions, STX-VCS was performed in 20 high-risk aneurysmal subarachnoid hemorrhage patients admitted to our department between September 2015 and October 2016. Three controls matched for age, sex, aneurysm treatment method, and admission Hunt and Hess grade were assigned to each case treated by STX-VCS. DCI was the primary outcome. Mortality and mRS at rehabilitation discharge were secondary outcome parameters. The association between STX-VCS and DCI, mortality, and mRS was assessed by conditional logistic regression.
RESULTS
Stereotactic procedures were performed without surgical complications. Continuous cisternal lavage was feasible in 17 of 20 patients (85%). One adverse event because of cisternal lavage was without sequelae. DCI occurred in 25 of 60 (42%) controls and 3 of 20 (15%) patients with STX-VCS (odds ratio, 0.15; 95% confidence interval, 0.04-0.64). Mortality occurred in 20 of 60 (33%) controls and 1 of 20 (5%) patients with STX-VCS, respectively (odds ratio, 0.08; 95% confidence interval, 0.01 - 0.66). Favorable outcome (mRS≤3) at rehabilitation discharge was observed in 12 of 20 patients with STX-VCS (60%) versus 21 of 60 (35%) matched controls (odds ratio, 0.26; 95% confidence interval, 0.8-0.86).
CONCLUSIONS
STX-VCS was feasible and safe in patients with severe aneurysmal subarachnoid hemorrhage. Initial results indicate that DCI and mortality can be reduced, and neurological outcome may be improved with this method.
背景与目的
迟发性脑梗死（DCI）是蛛网膜下腔出血后发病率和死亡率的主要原因。我们报告了一种新的干预措施——立体定向导管脑室外引流术（STX-VCS）联合纤维蛋白溶解/痉挛松解灌洗疗法——用于预防 DCI。将 20 例连续患者的结果与 60 例匹配对照进行比较。
方法
根据个体治疗决策，2015 年 9 月至 2016 年 10 月期间，我们科室收治的 20 例高危性蛛网膜下腔出血患者接受了 STX-VCS。为每个接受 STX-VCS 治疗的病例分配了 3 个年龄、性别、动脉瘤治疗方法和入院时 Hunt 和 Hess 分级相匹配的对照组。DCI 是主要结局。死亡率和康复出院时 mRS 是次要结局参数。采用条件逻辑回归评估 STX-VCS 与 DCI、死亡率和 mRS 的关系。
结果
立体定向手术无手术并发症。20 例患者中有 17 例（85%）可行连续脑池灌洗。1 例因脑池灌洗引起的不良事件无后遗症。60 例对照中有 25 例（42%）发生 DCI，20 例 STX-VCS 中有 3 例（15%）发生 DCI（比值比，0.15；95%置信区间，0.04-0.64）。60 例对照中有 20 例（33%）死亡，20 例 STX-VCS 中有 1 例（5%）死亡，（比值比，0.08；95%置信区间，0.01-0.66）。20 例 STX-VCS 中有 12 例（60%）康复出院时 mRS≤3，60 例匹配对照中有 21 例（35%）（比值比，0.26；95%置信区间，0.8-0.86）。
结论
STX-VCS 在严重蛛网膜下腔出血患者中是可行和安全的。初步结果表明，这种方法可以减少 DCI 和死亡率，改善神经功能预后。
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