鞍上池造瘘并脑池引流对动脉瘤性蛛网膜下腔出血后迟发性脑积水的积极影响。

The positive impact of cisternostomy with cisternal drainage on delayed hydrocephalus after aneurysmal subarachnoid hemorrhage.

机构信息

Department of Neurosurgery, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland.

Department of Radiology, Section of Neuroradiology, University Hospital of Lausanne, Lausanne, Switzerland.

出版信息

Acta Neurochir (Wien). 2023 Jan;165(1):187-195. doi: 10.1007/s00701-022-05445-x. Epub 2022 Dec 12.

DOI:10.1007/s00701-022-05445-x

PMID:36504078

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9840569/

Abstract

BACKGROUND

Hydrocephalus is one of the major complications of aneurysmal subarachnoid haemorrhage (aSAH). In the acute setting, an external ventricular drain (EVD) is used for early management. A cisternal drain (CD) coupled with the micro-surgical opening of basal cisterns can be an alternative when the aneurysm is clipped. Chronic hydrocephalus after aSAH is managed with ventriculo-peritoneal (VP) shunt, a procedure associated with a wide range of complications. The aim of this study is to analyse the impact of micro-surgical opening of basal cisterns coupled with CD on the incidence of VP shunt, compared to patients treated with EVD.

METHODS

The authors conducted a retrospective review of 89 consecutive cases of patients with aSAH treated surgically and endovascularly with either EVD or CD between January 2009 and September 2021. Patients were stratified into two groups: Group 1 included patients with EVD, Group 2 included patients with CD. Subgroup analysis with only patients treated surgically was also performed. We compared their baseline characteristics, clinical outcomes and shunting rates.

RESULTS

There were no statistically significant differences between the two groups in terms of epidemiological characteristics, WFNS score, Fisher scale, presence of intraventricular hemorrhage (IVH), acute hydrocephalus, postoperative meningitis or of clinical outcomes at last follow-up. Cisternostomy with CD (Group 2) was associated with a statistically significant reduction in VP-shunt compared with the use of an EVD (Group 1) (9.09% vs 53.78%; p < 0.001). This finding was confirmed in our subgroup analysis, as among patients with a surgical clipping, the rate of VP shunt was 43.7% for the EVD group and 9.5% for the CD group (p = 0.02).

CONCLUSIONS

Cisternostomy with CD may reduce the rate of shunt-dependent hydrocephalus. Cisternostomy allows the removal of subarachnoid blood, thereby reducing arachnoid inflammation and fibrosis. CD may enhance this effect, thus resulting in lower rates of chronic hydrocephalus.

摘要

背景

脑积水是颅内动脉瘤性蛛网膜下腔出血（aSAH）的主要并发症之一。在急性期，通常采用外部脑室引流（EVD）进行早期管理。当动脉瘤夹闭时，可采用脑池引流（CD）联合显微手术开放基底池作为替代方法。aSAH 后慢性脑积水采用脑室-腹腔（VP）分流术治疗，但该手术与多种并发症相关。本研究旨在分析与 EVD 相比，显微手术开放基底池联合 CD 对 VP 分流术发生率的影响。

方法

作者回顾性分析了 2009 年 1 月至 2021 年 9 月间采用 EVD 或 CD 治疗的 89 例连续接受手术和血管内治疗的 aSAH 患者。将患者分为两组：EVD 组（1 组）和 CD 组（2 组）。还进行了仅接受手术治疗的亚组分析。比较了两组患者的基线特征、临床结局和分流率。

结果

两组患者在流行病学特征、WFNS 评分、Fisher 分级、是否存在脑室内出血（IVH）、急性脑积水、术后脑膜炎或末次随访的临床结局方面均无统计学差异。与 EVD 组（1 组）相比，采用 CD 进行脑池造瘘（2 组）可显著降低 VP 分流术的发生率（9.09%比 53.78%；p<0.001）。在仅接受手术夹闭的患者中，EVD 组和 CD 组的 VP 分流率分别为 43.7%和 9.5%（p=0.02），该发现也在我们的亚组分析中得到了证实。