Department of Neurosurgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri, Gyonggi-do, Korea.
Sci Rep. 2018 Jul 5;8(1):10178. doi: 10.1038/s41598-018-28471-1.
Hydrocephalus is a common complication following subarachnoid haemorrhage (SAH) arising from spontaneous aneurysm rupture. The Hounsfield unit (HU) value from computed tomography scans may reflect bone mineral density, which correlates with body mass index, which in turn is related to post-SAH ventricle size changes. We herein investigated potential associations between frontal skull HU values and ventricle size changes after SAH. HU values from four different areas in the frontal bone were averaged to minimize measurement errors. The bicaudate index and Evans ratio were measured using both baseline and follow-up CT images. CT images with bicaudate index >0.2 and Evans ratio >0.3 simultaneously were defined as indicating ventriculomegaly. We included 232 consecutive patients with SAH due to primary spontaneous aneurysm rupture, who underwent clipping over almost a 9-year period at a single institution. The first tertile of frontal skull HU values in older patients (≥55 years) was an independent predictor of ventriculomegaly after SAH, as compared to the third tertile in younger patients (hazard ratio, 4.01; 95% confidence interval 1.21-13.30; p = 0.023). The lower frontal skull HU value independently predicted ventricular enlargement post-SAH, due to the potential weak integrity of subarachnoid trabecular structures in younger patients.
脑积水是自发性蛛网膜下腔出血（SAH）后常见的并发症，其由动脉瘤破裂引起。计算机断层扫描（CT）的亨氏单位（HU）值可能反映骨矿物质密度，而骨矿物质密度与体重指数相关，体重指数又与蛛网膜下腔出血后脑室大小的变化相关。本研究旨在探讨额骨 HU 值与蛛网膜下腔出血后脑室大小变化之间的潜在关联。通过平均额骨四个不同区域的 HU 值，以尽量减少测量误差。使用基线和随访 CT 图像测量大脑脚指数和 Evans 比值。将大脑脚指数>0.2 且 Evans 比值>0.3 的 CT 图像定义为脑室扩大。我们纳入了 232 例因原发性自发性动脉瘤破裂导致蛛网膜下腔出血的连续患者，这些患者在一家机构接受了近 9 年的夹闭手术。与年轻患者（第三 tertile）相比，老年患者（≥55 岁）额骨 HU 值的第一个 tertile 是蛛网膜下腔出血后脑室扩大的独立预测因子（危险比，4.01；95%置信区间 1.21-13.30；p=0.023）。额骨 HU 值较低可独立预测蛛网膜下腔出血后脑室扩大，这可能是由于年轻患者蛛网膜下腔小梁结构的潜在完整性较弱。
