Department of Neurosurgery and Spine Surgery, University Hospital of Essen, Essen, Germany.
Department of Neurosurgery and Spine Surgery, Evangelisches Krankenhaus Oldenburg, Oldenburg, Germany.
Acta Neurochir (Wien). 2023 Jun;165(6):1545-1555. doi: 10.1007/s00701-023-05595-6. Epub 2023 May 2.
Chronic hydrocephalus requiring shunt placement is a common complication of aneurysmal subarachnoid hemorrhage (SAH). Different risk factors and prediction scores for post-SAH shunt dependency have been evaluated so far. We analyzed the value of ventricle measurements for prediction of the need for shunt placement in SAH patients.
Eligible SAH cases treated between 01/2003 and 06/2016 were included. Initial computed tomography scans were reviewed to measure ventricle indices (bifrontal, bicaudate, Evans', ventricular, Huckman's, and third ventricle ratio). Previously introduced CHESS and SDASH scores for shunt dependency were calculated. Receiver operating characteristic analyses were performed for diagnostic accuracy of the ventricle indices and to identify the clinically relevant cut-offs.
Shunt placement followed in 221 (36.5%) of 606 patients. In univariate analyses, all ventricular indices were associated with shunting (all: p<0.0001). The area under the curve (AUC) ranged between 0.622 and 0.662. In multivariate analyses, only Huckman's index was associated with shunt dependency (cut-off at ≥6.0cm, p<0.0001) independent of the CHESS score as baseline prediction model. A combined score (0-10 points) containing the CHESS score components (0-8 points) and Huckman's index (+2 points) showed better diagnostic accuracy (AUC=0.751) than the CHESS (AUC=0.713) and SDASH (AUC=0.693) scores and the highest overall model quality (0.71 vs. 0.65 and 0.67), respectively.
Ventricle measurements are feasible for early prediction of shunt placement after SAH. The combined prediction model containing the CHESS score and Huckman's index showed remarkable diagnostic accuracy regarding identification of SAH individuals requiring shunt placement. External validation of the presented combined CHESS-Huckman score is mandatory.
需要放置分流器的慢性脑积水是蛛网膜下腔出血（SAH）的常见并发症。迄今为止，已经评估了不同的与 SAH 后分流依赖相关的风险因素和预测评分。我们分析了脑室测量值对预测 SAH 患者需要分流的价值。
纳入 2003 年 1 月至 2016 年 6 月期间治疗的符合条件的 SAH 病例。回顾初始计算机断层扫描以测量脑室指数（额双、双尾状核、Evans'、脑室、Huckman'和第三脑室比值）。计算了用于分流依赖的先前引入的 CHESS 和 SDASH 评分。进行了接收器操作特征分析，以评估脑室指数的诊断准确性，并确定临床相关的截止值。
2016 年 6 月期间治疗的 606 例患者中，221 例（36.5%）需要放置分流器。在单变量分析中，所有脑室指数均与分流相关（均：p<0.0001）。曲线下面积（AUC）范围在 0.622 至 0.662 之间。在多变量分析中，只有 Huckman 指数与分流依赖相关（截止值≥6.0cm，p<0.0001），独立于作为基线预测模型的 CHESS 评分。包含 CHESS 评分成分（0-8 分）和 Huckman 指数（+2 分）的综合评分（0-10 分）显示出比 CHESS（AUC=0.713）和 SDASH（AUC=0.693）评分更好的诊断准确性（AUC=0.751），并且整体模型质量最高（分别为 0.71、0.65 和 0.67）。
脑室测量值可用于早期预测 SAH 后分流放置。包含 CHESS 评分和 Huckman 指数的联合预测模型在确定需要分流的 SAH 个体方面显示出显著的诊断准确性。需要对所提出的联合 CHESS-Huckman 评分进行外部验证。
