自发性颅内低血压患者行硬膜外血贴后复发的预测因素。

Factors to predict recurrence after epidural blood patch in patients with spontaneous intracranial hypotension.

机构信息

Department of Neurology, Seoul Medical Center, Seoul, South Korea.

Department of Applied Statistics, Chung-Ang University, Seoul, South Korea.

出版信息

Headache. 2024 Apr;64(4):380-389. doi: 10.1111/head.14703. Epub 2024 Apr 18.

DOI:10.1111/head.14703

PMID:38634709

Abstract

OBJECTIVES

This study aimed to identify predictors for the recurrence of spontaneous intracranial hypotension (SIH) after epidural blood patch (EBP).

BACKGROUND

Epidural blood patch is the main treatment option for SIH; however, the characteristics of patients who experience relapse after successful EBP treatment for SIH remain understudied.

METHODS

In this exploratory, retrospective, case-control study, we included 19 patients with SIH recurrence after EBP and 36 age- and sex-matched patients without recurrence from a single tertiary medical institution. We analyzed clinical characteristics, neuroimaging findings, and volume changes in intracranial structures after EBP treatment. Machine learning methods were utilized to predict the recurrence of SIH after EBP treatment.

RESULTS

There were no significant differences in clinical features between the recurrence and no-recurrence groups. Among brain magnetic resonance imaging signs, diffuse pachymeningeal enhancement and cerebral venous dilatation were more prominent in the recurrence group than no-recurrence group after EBP (14/19 [73%] vs. eight of 36 [22%] patients, p = 0.001; 11/19 [57%] vs. seven of 36 [19%] patients, p = 0.010, respectively). The midbrain-pons angle decreased in the recurrence group compared to the no-recurrence group after EBP, at a mean (standard deviation [SD]) of -12.0 [16.7] vs. +1.8[18.3]° (p = 0.048). In volumetric analysis, volume changes after EBP were smaller in the recurrence group than in the no-recurrence group in intracranial cerebrospinal fluid (mean [SD] -11.6 [15.3] vs. +4.8 [17.1] mL, p = 0.001) and ventricles (mean [SD] +1.0 [2.0] vs. +2.0 [2.5] mL, p = 0.003). Notably, the random forest classifier indicated that the model constructed with brain volumetry was more accurate in discriminating SIH recurrence (area under the curve = 0.80 vs. 0.52).

CONCLUSION

Our study suggests that volumetric analysis of intracranial structures may aid in predicting recurrence after EBP treatment in patients with SIH.

摘要

目的

本研究旨在确定硬膜外血贴（EBP）治疗后自发性颅内低血压（SIH）复发的预测因素。

背景

EBP 是 SIH 的主要治疗选择；然而，对于 EBP 治疗成功后经历复发的患者的特征，研究仍不够充分。

方法

在这项探索性、回顾性、病例对照研究中，我们纳入了来自一家三级医疗机构的 19 例 EBP 治疗后 SIH 复发患者和 36 例年龄和性别匹配的无复发患者。我们分析了临床特征、神经影像学表现和 EBP 治疗后颅内结构的容积变化。利用机器学习方法预测 EBP 治疗后 SIH 的复发。

结果

复发组和无复发组在临床特征方面无显著差异。在脑磁共振成像征象中，弥漫性硬脑膜强化和脑静脉扩张在 EBP 后更明显（19 例患者中有 14 例[73%]与 36 例患者中有 8 例[22%]相比，p=0.001；19 例患者中有 11 例[57%]与 36 例患者中有 7 例[19%]相比，p=0.010）。EBP 后中脑 - 脑桥角在复发组较无复发组减小，平均（标准差）为-12.0[16.7]°与+1.8[18.3]°（p=0.048）。在容积分析中，EBP 后颅内脑脊液（平均[标准差] -11.6[15.3]与+4.8[17.1]mL，p=0.001）和脑室（平均[标准差] +1.0[2.0]与+2.0[2.5]mL，p=0.003）的容积变化在复发组较无复发组小。值得注意的是，随机森林分类器表明，基于脑容积的模型在区分 SIH 复发方面更准确（曲线下面积=0.80 与 0.52）。