From the Department of Neurosurgery, Hanyang University Guri Hospital, Korea (M.-H.H., Y.D.W., M.K.N., C.H.K., J.M.K., J.I.R., J.H.C.).
Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea (H.-J.Y.).
Stroke. 2018 Aug;49(8):1850-1858. doi: 10.1161/STROKEAHA.118.021063.
Background and Purpose- Pathological obstruction in arachnoid granulations after subarachnoid hemorrhage (SAH) can impede cerebrospinal fluid flow outward to the venous sinus and causing hydrocephalus. Because bone and arachnoid granulations share the same collagen type, we evaluated the possible relation between bone mineral density and shunt-dependent hydrocephalus after SAH. Methods- We measured Hounsfield units of the frontal skull on admission brain computed tomography in patients with SAH. Receiver operating characteristic curve analysis was performed to determine the optimal cutoff Hounsfield unit in skull to predict osteopenia and osteoporosis in a large sample registry. According to the optimal cutoff skull Hounsfield unit values, study patients were then categorized as hypothetical normal, osteopenia, and osteoporosis. Odds ratios were estimated using logistic regression to determine whether the osteoporotic conditions are independent predictive factors for the development of shunt-dependent hydrocephalus after clipping for SAH. Results- A total of 447 patients (alive ≥14 days) with ruptured aneurysm SAH who underwent surgical clipping were retrospectively enrolled in this study during a 9-year period from 2 hospitals. We found that hypothetical osteoporosis was an independent predictor for shunt-dependent hydrocephalus after aneurysmal clipping for SAH after full adjustment for other predictive factors, including age (odds ratio, 2.08; 95% confidence interval, 1.06-4.08; P=0.032). Conclusions- Our study demonstrates a possible relation between possible osteoporosis and hydrocephalus after SAH. Hounsfield unit measurement on admission brain computed tomography may be helpful for predicting hydrocephalus during the clinical course of SAH in patients with osteoporosis or suspected osteoporosis.
背景与目的-蛛网膜颗粒在蛛网膜下腔出血（SAH）后发生病理性阻塞，可阻碍脑脊液向外流入静脉窦，导致脑积水。由于骨和蛛网膜颗粒具有相同的胶原类型，我们评估了 SAH 后骨密度与分流依赖性脑积水之间的可能关系。方法-我们测量了 SAH 患者入院时脑计算机断层扫描的额骨颅骨的亨氏单位。进行了受试者工作特征曲线分析，以确定颅骨的最佳截断亨氏单位，以在大型样本登记处预测骨质疏松症和骨质疏松症。根据颅骨的最佳截断亨氏单位值，将研究患者分类为假设正常、骨质疏松症和骨质疏松症。使用逻辑回归估计比值比，以确定骨质疏松症状况是否是 SAH 夹闭后发生分流依赖性脑积水的独立预测因素。结果-在 2 家医院的 9 年期间，共回顾性纳入了 447 例（存活≥14 天）接受手术夹闭的破裂性颅内动脉瘤 SAH 患者。我们发现，在对包括年龄在内的其他预测因素进行充分调整后，假设骨质疏松症是 SAH 夹闭后发生分流依赖性脑积水的独立预测因素（比值比，2.08；95%置信区间，1.06-4.08；P=0.032）。结论-我们的研究表明，SAH 后可能存在骨质疏松症与脑积水之间的关系。入院时脑计算机断层扫描的亨氏单位测量值可能有助于预测骨质疏松症或疑似骨质疏松症患者 SAH 病程中的脑积水。
