Hospital Universitario Miguel Servet, Zaragoza, Spain.
Hospital Universitario Miguel Servet, Zaragoza, Spain.
Neurocirugia (Astur : Engl Ed). 2024 Jul-Aug;35(4):196-204. doi: 10.1016/j.neucie.2024.03.002. Epub 2024 Mar 6.
Subarachnoid haemorrhage (SAH) is one of the most frequent neurosurgical emergencies, most of them due to intracranial aneurysm rupture. Hydrocephalus is a prevalent complication with a high rate of complications. The aims of this study are to identify predictors of shunt-dependent hydrocephalus following aneurysmal SAH and to quantify the complications arising from ventriculoperitoneal shunts.
This study is about an observational retrospective analytic study of the patients with spontaneous SAH admitted to Miguel Servet Universitary Hospital between 2017 and 2022. Patients' clinical and radiological characteristics, type of treatment, diagnoses and treatment of hydrocephalus, complications of ventriculoperitoneal shunts and mortality are some of the data achieved in this study. A descriptive study of these variables has been done and, subsequently, the most relevant variables have been statistically analysed to identify patients with increasing risk of shunting for hydrocephalus. This study was authorized by the Ethics Committee prior to its elaboration.
A total of 359 patients with spontaneous SAH were admitted to Miguel Servet Universitary Hospital between 2017 and 2022, with an intrahospitalary death rate of 25.3%. 66.3% of the total of patients with SAH were due to intracranial aneurysm rupture (n = 238). 45.3% of the patients with aneurysmal SAH required an external ventricular drain (EVD) to treat acute hydrocephalus. 11.7% (n = 28) developed a shunt-dependent hydrocephalus. Statistical significance was found between shunt-dependent hydrocephalus and the following: high score in modified Fisher scale and placement of EVD. The mean interval from EVD to ventriculoperitoneal shunt placement was 26.1 days. The mean rate of reoperation of patients after shunt was 17.7%, mostly due to infection.
The most significant risk factor for shunt-dependent hydrocephalus after aneurysmal SAH was high Fisher grade and previous need of EVD. Shunt infections is the main cause of shunt reoperation. Early shunt placement in selected patients might reduce the rate of infectious complications.
蛛网膜下腔出血（SAH）是最常见的神经外科急症之一，大多数是由于颅内动脉瘤破裂引起的。脑积水是一种常见的并发症，其并发症发生率很高。本研究的目的是确定颅内动脉瘤性 SAH 后发生分流依赖性脑积水的预测因素，并量化脑室-腹腔分流术引起的并发症。
本研究为回顾性观察性分析研究，纳入 2017 年至 2022 年期间入住 Miguel Servet 大学医院的自发性 SAH 患者。本研究获得了患者的临床和影像学特征、治疗类型、脑积水的诊断和治疗、脑室-腹腔分流术并发症和死亡率等数据。对这些变量进行了描述性研究，随后对最相关的变量进行了统计学分析，以确定发生分流依赖性脑积水风险增加的患者。本研究在制定前得到了伦理委员会的授权。
2017 年至 2022 年间，共有 359 例自发性 SAH 患者入住 Miguel Servet 大学医院，院内死亡率为 25.3%。颅内动脉瘤破裂导致的 SAH 患者占总数的 66.3%（n=238）。需要外部脑室引流（EVD）治疗急性脑积水的患者占 45.3%（n=28）。11.7%（n=28）发生分流依赖性脑积水。分流依赖性脑积水与改良 Fisher 量表评分高和 EVD 放置之间存在统计学意义。EVD 至脑室-腹腔分流术放置的平均时间间隔为 26.1 天。分流后患者再手术的平均比率为 17.7%，主要原因是感染。
颅内动脉瘤性 SAH 后发生分流依赖性脑积水的最重要危险因素是高 Fisher 分级和先前需要 EVD。分流感染是分流再手术的主要原因。在选择的患者中早期放置分流管可能会降低感染并发症的发生率。
