Wang Alvin Yi-Chou, Hsieh Po-Chuan, Chen Ching-Chang, Chin Shy-Chyi, Wu Yi-Ming, Chen Chun-Ting, Chang Chien-Hung, Wu Tai-Wei Erich
Department of Neurosurgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China.
Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University and Medical College, Taiwan, Republic of China.
World Neurosurg. 2018 Dec;120:e290-e296. doi: 10.1016/j.wneu.2018.08.053. Epub 2018 Aug 22.
Increased intracranial pressure (ICP) is a well-known complication after aneurysmal subarachnoid hemorrhage (aSAH). This study focused on the different temporal changes in ICP, mean arterial pressure, and cerebral perfusion pressure at the early stage of aSAH, throughout aneurysm embolization, and their effects on improvement in angiographic perfusion patterns.
Twenty-seven patients with aSAH were evaluated who underwent coiling and cerebrospinal fluid (CSF) drainage. Diagnostic angiography was performed to confirm the presence and location of the vascular lesion. The transit time of the capillary filling phase was defined as a surrogate of cerebral perfusion. Capillary filling transit times were compared before and after CSF drainage. Univariate and multivariate analyses were performed to identify associations between different physical parameters and capillary filling transit times.
By univariate analysis, average capillary transit time before CSF drainage had a significant correlation with initial ICP (P = 0.0004; R = 0.398) but not systemic pressure (mean arterial pressure or cerebral perfusion pressure). Improvement in capillary filling pattern (i.e., a decrease in angiographic capillary transit time after CSF drainage) was seen in patients with high initial ICP and correlated with ICP difference after ventricular drainage (P = 0.0001 and P < 0.0001, respectively). Using multivariate regression analysis, improved control in postprocedural ICP levels significantly correlated with angiographic evidence of improved cerebral perfusion (P = 0.0243).
Decreasing ICP by CSF drainage strongly correlated with improved cerebral microcirculation after aSAH. Further development of ICP control protocols that can provide better ICP management of patients with aSAH is warranted.
颅内压（ICP）升高是动脉瘤性蛛网膜下腔出血（aSAH）后一种众所周知的并发症。本研究聚焦于aSAH早期、整个动脉瘤栓塞过程中ICP、平均动脉压和脑灌注压的不同时间变化，以及它们对血管造影灌注模式改善的影响。
对27例接受线圈栓塞和脑脊液（CSF）引流的aSAH患者进行评估。进行诊断性血管造影以确认血管病变的存在和位置。将毛细血管充盈期的通过时间定义为脑灌注的替代指标。比较CSF引流前后的毛细血管充盈通过时间。进行单因素和多因素分析以确定不同物理参数与毛细血管充盈通过时间之间的关联。
单因素分析显示，CSF引流前的平均毛细血管通过时间与初始ICP显著相关（P = 0.0004；R = 0.398），但与全身压力（平均动脉压或脑灌注压）无关。初始ICP高的患者可见毛细血管充盈模式改善（即CSF引流后血管造影毛细血管通过时间缩短），且与脑室引流后的ICP差值相关（分别为P = 0.0001和P < 0.0001）。使用多因素回归分析，术后ICP水平的改善控制与脑灌注改善的血管造影证据显著相关（P = 0.0243）。
通过CSF引流降低ICP与aSAH后脑微循环改善密切相关。有必要进一步制定能更好地管理aSAH患者ICP的控制方案。
