Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.
World Neurosurg. 2023 Jul;175:e925-e939. doi: 10.1016/j.wneu.2023.04.043. Epub 2023 Apr 17.
Hydrocephalus is a common complication after aneurysmal subarachnoid hemorrhage (aSAH). This study aimed to evaluate novel preoperative and postoperative risk factors for shunt-dependent hydrocephalus (SDHC) after aSAH via a systematic review and meta-analysis.
A systematic search was conducted using PubMed and Embase databases for studies pertaining to aSAH and SDHC. Articles were assessed by meta-analysis if the number of risk factors for SDHC was reported by >4 studies and could be extracted separately for patients who did or did not develop SDHC.
Thirty-seven studies were included, comprising 12,667 patients with aSAH (SDHC 2214 vs. non-SDHC 10,453). In a primary analysis of 15 novel potential risk factors, 8 were identified to be significantly associated with increased prevalence of SDHC after aSAH, including high World Federation of Neurological Surgeons grades (odds ratio [OR], 2.43), hypertension (OR, 1.33), anterior cerebral artery (OR, 1.36), middle cerebral artery (OR, 0.65), and vertebrobasilar artery (2.21) involvement, decompressive craniectomy (OR, 3.27), delayed cerebral ischemia (OR, 1.65), and intracerebral hematoma (OR, 3.91).
Several new factors associated with increased odds of developing SDHC after aSAH were found to be significant. By providing evidence-based risk factors for shunt dependency, we describe an identifiable list of preoperative and postoperative prognosticators that may influence how surgeons recognize, treat, and manage patients with aSAH at high risk for developing SDHC.
脑积水是蛛网膜下腔出血（aSAH）后的常见并发症。本研究旨在通过系统回顾和荟萃分析评估 aSAH 后与分流依赖性脑积水（SDHC）相关的新术前和术后危险因素。
通过 PubMed 和 Embase 数据库对与 aSAH 和 SDHC 相关的研究进行系统搜索。如果有>4 项研究报告了 SDHC 的危险因素数量，并且可以分别提取出发生或未发生 SDHC 的患者的危险因素，则对这些文章进行荟萃分析评估。
共纳入 37 项研究，包括 12667 例 aSAH 患者（SDHC 2214 例，非 SDHC 10453 例）。在对 15 个新的潜在危险因素的初步分析中，有 8 个被确定与 aSAH 后 SDHC 的发生率增加显著相关，包括较高的世界神经外科学联合会分级（优势比[OR]，2.43）、高血压（OR，1.33）、前交通动脉（OR，1.36）、大脑中动脉（OR，0.65）和椎基底动脉（2.21）受累、去骨瓣减压术（OR，3.27）、迟发性脑缺血（OR，1.65）和脑内血肿（OR，3.91）。
发现了一些与 aSAH 后发生 SDHC 风险增加相关的新危险因素。通过提供与分流依赖性相关的循证风险因素，我们描述了一组可识别的术前和术后预后指标，这些指标可能会影响外科医生如何识别、治疗和管理发生 SDHC 风险较高的 aSAH 患者。
