Department of Neurosurgery, Kantonsspital Aarau, Aargau, Switzerland.
Department of Radiology, Division of Neuroradiology, Kantonsspital Aarau, Aargau, Switzerland.
Neurosurg Rev. 2023 Nov 16;46(1):302. doi: 10.1007/s10143-023-02203-0.
Shunt-dependent hydrocephalus (HC) is a common sequela following aneurysmal subarachnoid hemorrhage (aSAH). However, there is still poor evidence regarding the optimal timing of ventriculoperitoneal shunt (VPS) placement, particularly in the context of early aSAH-associated complications such as delayed cerebral ischemia (DCI). The purpose of this study was to compare the impact of early (< 21 days after aSAH) versus late (≥ 21 days after aSAH) VPS placement on the functional clinical outcome. We retrospectively analyzed data from 82 patients with VPS placement after aSAH enrolled in our institutional database between 2011 and 2021. We compared two groups, early VPS placement (< 21 days after aSAH) versus late VPS placement (≥ 21 days after aSAH) in terms of demographics, SAH grading, radiological parameters, externalized cerebrospinal fluid diversions, DCI, VPS variables, and functional outcome. We identified 53 patients with early and 29 patients with late VPS implantation. Baseline variables, such as the modified Rankin Scale (mRS), the World Federation of Neurological Surgeons Scale, the Glasgow Coma Scale, and Fisher grade were not significantly different between the groups. Postoperatively, the mRS (p = 0.0037), the Glasgow Outcome Scale (p = 0.0037), and the extended Glasgow Outcome Scale (p = 0.0032) showed significantly better functional results in patients with early cerebrospinal fluid diversion. The rate of DCI did not differ significantly between the groups (p = 0.53). There was no difference in the rate of VPS placement associated complications (p = 0.44) or overall mortality (p = 0.39). Early shunt implantation, within 21 days after aSAH and therefore during the timeframe of possible DCI, might not be harmful in patients developing HC after aSAH.
分流依赖性脑积水（HC）是蛛网膜下腔出血（aSAH）后的常见后遗症。然而，关于最佳脑室-腹腔分流术（VPS）放置时间，特别是在早期与 aSAH 相关的并发症（如迟发性脑缺血（DCI））的背景下，仍然缺乏有力的证据。本研究旨在比较早期（aSAH 后<21 天）与晚期（aSAH 后≥21 天）VPS 放置对功能临床结局的影响。我们回顾性分析了 2011 年至 2021 年期间在我院数据库中接受 VPS 治疗的 82 例 aSAH 患者的数据。我们比较了两组患者，即早期 VPS 放置（aSAH 后<21 天）与晚期 VPS 放置（aSAH 后≥21 天），比较了两组的人口统计学、aSAH 分级、影像学参数、外引流脑脊液、DCI、VPS 变量和功能结局。我们发现 53 例患者接受了早期 VPS 植入，29 例患者接受了晚期 VPS 植入。两组间的基线变量，如改良 Rankin 量表（mRS）、世界神经外科学会量表、格拉斯哥昏迷量表和 Fisher 分级无显著差异。术后 mRS（p=0.0037）、格拉斯哥结局量表（p=0.0037）和扩展格拉斯哥结局量表（p=0.0032）显示早期脑脊液引流患者的功能结果显著改善。两组 DCI 发生率无显著差异（p=0.53）。VPS 放置相关并发症发生率（p=0.44）或总死亡率（p=0.39）无差异。在 aSAH 后发生 HC 的患者中，早期（aSAH 后 21 天内）即可能发生 DCI 的时间窗内，植入分流管可能不会造成伤害。
