Stricker Sarah, Boulouis Grégoire, Benichi Sandro, Gariel Florent, Garzelli Lorenzo, Beccaria Kevin, Chivet Anais, de Saint Denis Timothee, James Syril, Paternoster Giovanna, Zerah Michel, Bourgeois Marie, Boddaert Nathalie, Brunelle Francis, Meyer Philippe, Puget Stephanie, Naggara Olivier, Blauwblomme Thomas
1APHP, Necker Hospital, Université de Paris.
2Department of Neuroradiology, INSERM U1266.
J Neurosurg Pediatr. 2020 May 22;26(3):283-287. doi: 10.3171/2020.3.PEDS19680. Print 2020 Sep 1.
Hydrocephalus is a strong determinant of poor neurological outcome after intracerebral hemorrhage (ICH). In children, ruptured brain arteriovenous malformations (bAVMs) are the dominant cause of ICH. In a large prospective cohort of pediatric patients with ruptured bAVMs, the authors analyzed the rates and predictive factors of hydrocephalus requiring acute external ventricular drainage (EVD) or ventriculoperitoneal shunt (VPS).
The authors performed a single-center retrospective analysis of the data from a prospectively maintained database of children admitted for a ruptured bAVM since 2002. Admission clinical and imaging predictors of EVD and VPS placement were analyzed using univariate and multivariate statistical models.
Among 114 patients (mean age 9.8 years) with 125 distinct ICHs due to ruptured bAVM, EVD and VPS were placed for 55/125 (44%) hemorrhagic events and 5/114 patients (4.4%), respectively. A multivariate nominal logistic regression model identified low initial Glasgow Coma Scale (iGCS) score, hydrocephalus on initial CT scan, the presence of intraventicular hemorrhage (IVH), and higher modified Graeb Scale (mGS) score as strongly associated with subsequent need for EVD (all p < 0.001). All children who needed a VPS had initial hydrocephalus requiring EVD and tended to have higher mGS scores.
In a large cohort of pediatric patients with ruptured bAVM, almost half of the patients required EVD and 4.4% required permanent VPS. Use of a low iGCS score and a semiquantitative mGS score as indicators of the IVH burden may be helpful for decision making in the emergency setting and thus improve treatment.
脑积水是脑出血（ICH）后神经功能预后不良的一个重要决定因素。在儿童中，破裂的脑动静脉畸形（bAVM）是ICH的主要病因。在一个大型前瞻性儿科破裂bAVM患者队列中，作者分析了需要进行急性脑室外引流（EVD）或脑室腹腔分流术（VPS）的脑积水发生率及预测因素。
作者对自2002年以来因破裂bAVM入院的儿童前瞻性维护数据库中的数据进行了单中心回顾性分析。使用单变量和多变量统计模型分析EVD和VPS置入的入院临床及影像学预测因素。
在114例（平均年龄9.8岁）因破裂bAVM导致125处不同ICH的患者中，分别有55/125（44%）次出血事件和5/114例患者（4.4%）接受了EVD和VPS治疗。多变量名义逻辑回归模型确定，初始格拉斯哥昏迷量表（iGCS）评分低、初始CT扫描显示脑积水、脑室内出血（IVH）的存在以及改良格雷布量表（mGS）评分较高与随后需要EVD密切相关（所有p<0.001）。所有需要VPS的儿童最初都有需要EVD的脑积水，且mGS评分往往更高。
在一大群患有破裂bAVM的儿科患者中，近一半的患者需要EVD，4.4%的患者需要永久性VPS。使用低iGCS评分和半定量mGS评分作为IVH负担的指标可能有助于在紧急情况下进行决策，从而改善治疗。
