Lenski Markus, Biczok Annamaria, Huge Volker, Forbrig Robert, Briegel Josef, Tonn Jörg-Christian, Thon Niklas
Neurochirurgische Klinik und Poliklinik, Klinikum Großhadern, Ludwig Maximilian Universität, Munich, Germany.
Neurochirurgische Klinik und Poliklinik, Klinikum Großhadern, Ludwig Maximilian Universität, Munich, Germany.
World Neurosurg. 2019 Jan;121:e535-e542. doi: 10.1016/j.wneu.2018.09.159. Epub 2018 Sep 27.
We sought to identify potential risk factors for the development of shunt-dependent chronic hydrocephalus after aneurysmal subarachnoid hemorrhage (SAH) and external ventricular drain (EVD) insertion. In particular, the role of inflammatory markers within the cerebrospinal fluid (CSF) was assessed.
For this single-center analysis, data were generated from consecutive patients with SAH and the need for EVD implantation treated on our neurosurgical intensive care unit between 2013 and 2015. Parameters were patient characteristics (age, sex, comorbidity), severity of SAH (according to the World Federation of Neurological Society score), imaging findings (intraventricular hemorrhage, diameter of the third ventricle, location of the ruptured aneurysm), and acute course of disease (cerebral infarction, vasospasm). Moreover, the impact of EVD drainage volume and CSF markers (total protein [TP], red blood cell count [RBC], interleukin-6 [IL-6], and glucose [Glc]) was assessed. Statistics including receiver-operating-curve with corresponding area-under-the-curve (AUC) analysis were calculated using SPSS.
Overall, 63 patients (21 males, mean age 55.2 years) were included. Twenty-one patients (30%) developed a shunt-dependent hydrocephalus. Significant risk factors for shunt dependency were the World Federation of Neurological Society score, cerebral infarction, and diameter of the third ventricle (P < 0.05). Moreover, CSF markers associated with shunt-dependent hydrocephalus included increased levels of TP on days 5 (AUC = 0.72)/11 (AUC = 0.97)/14 (AUC = 0.98), IL-6 on day 14 (AUC = 0.81), and RBC on day 15 (AUC = 0.83). The EVD drainage volume was not prognostic.
The time course of selected inflammatory markers in CSF may support management considerations in the early phase after SAH and critical impairment of CSF circulation.
我们试图确定动脉瘤性蛛网膜下腔出血（SAH）和置入脑室外引流管（EVD）后发生分流依赖型慢性脑积水的潜在风险因素。尤其评估了脑脊液（CSF）中炎症标志物的作用。
对于这项单中心分析，数据来自2013年至2015年间在我们神经外科重症监护病房接受治疗的连续SAH患者及需要植入EVD的患者。参数包括患者特征（年龄、性别、合并症）、SAH严重程度（根据世界神经外科联合会评分）、影像学表现（脑室内出血、第三脑室直径、破裂动脉瘤位置）以及疾病急性期过程（脑梗死、血管痉挛）。此外，评估了EVD引流量和CSF标志物（总蛋白[TP]、红细胞计数[RBC]、白细胞介素-6[IL-6]和葡萄糖[Glc]）的影响。使用SPSS计算包括受试者操作曲线及相应曲线下面积（AUC）分析在内的统计数据。
总共纳入63例患者（21例男性，平均年龄55.2岁）。21例患者（30%）发生了分流依赖型脑积水。分流依赖的显著风险因素为世界神经外科联合会评分、脑梗死和第三脑室直径（P<0.05）。此外，与分流依赖型脑积水相关的CSF标志物包括第5天（AUC=0.72）/第11天（AUC=0.97）/第14天（AUC=0.98）TP水平升高、第14天IL-6水平升高（AUC=0.81）以及第15天RBC水平升高（AUC=0.83）。EVD引流量无预后价值。
CSF中特定炎症标志物的时间进程可能有助于SAH后早期阶段以及CSF循环严重受损时的管理决策。
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