Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Klongluang, Pathumthani, Thailand.
Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Klongluang, Pathumthani, Thailand.
World Neurosurg. 2023 Nov;179:e575-e581. doi: 10.1016/j.wneu.2023.09.008. Epub 2023 Sep 7.
Hydrocephalus remains a common sequela of intraventricular hemorrhage (IVH) despite adequate drainage of the hematoma, including endoscopic surgery, intraventricular fibrinolysis, and external ventricular drainage (EVD). Moreover, the appropriate timing for conversion from EVD to ventriculoperitoneal shunt (VPS) is uncertain. This study aimed to evaluate the predictors of shunt dependency in patients with IVH based on the early EVD weaning protocol in our institution.
We retrospectively reviewed medical records of patients who were diagnosed with primary IVH and secondary IVH from spontaneous intracerebral hemorrhage during the period 2018-2021. Predictors associated with shunt dependency were identified using a logistic regression model. The cutoff point of each variable was selected by receiver operating characteristic curve analysis. Furthermore, shunt complications were reported as a safety measure of our early EVD weaning protocol.
The analysis included 106 patients. After IVH treatment, 15 (14%) patients required ventriculoperitoneal shunt, whereas 91 (86%) patients were shunt-free. The diameter of posttreatment temporal horn and the degree of IVH reduction were the significant predictors of shunt dependency. Moreover, patients with IVH reduction of >45% and temporal horn diameter of <9 mm had a lower probability of shunt dependency. Shunt failure was found in 2 (13.3%) patients.
This study showed that a large temporal horn diameter and a lower degree of IVH removal were predictors of shunt dependency in patients with IVH. In addition, early conversion from EVD to ventriculoperitoneal shunt is safe and feasible.
尽管血肿引流充分，包括内镜手术、脑室内纤维溶解和脑室外引流（EVD），脑积水仍然是脑室出血（IVH）的常见后遗症。此外，从 EVD 转为脑室-腹腔分流术（VPS）的合适时机尚不确定。本研究旨在根据我院的早期 EVD 脱机方案，评估 IVH 患者发生分流依赖的预测因素。
我们回顾性分析了 2018 年至 2021 年期间因自发性脑出血而被诊断为原发性 IVH 和继发性 IVH 的患者的病历。使用逻辑回归模型确定与分流依赖相关的预测因素。通过接收者操作特征曲线分析选择每个变量的截止点。此外，作为我们早期 EVD 脱机方案的安全性措施，报告了分流并发症。
分析共纳入 106 例患者。IVH 治疗后，15 例（14%）患者需要脑室-腹腔分流术，91 例（86%）患者无需分流术。治疗后颞角直径和 IVH 减少程度是分流依赖的显著预测因素。此外，IVH 减少>45%和颞角直径<9mm 的患者发生分流依赖的可能性较低。2 例（13.3%）患者发生分流失败。
本研究表明，大的颞角直径和较低的 IVH 清除程度是 IVH 患者发生分流依赖的预测因素。此外，早期从 EVD 转为脑室-腹腔分流术是安全可行的。
