Department of Neurosurgery, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany.
Acta Neurochir (Wien). 2024 May 28;166(1):234. doi: 10.1007/s00701-024-06131-w.
Progressive cerebral edema with refractory intracranial hypertension (ICP) requiring decompressive hemicraniectomy (DHC) is a severe manifestation of early brain injury (EBI) after aneurysmal subarachnoid hemorrhage (aSAH). The purpose of the study was to investigate whether a more pronounced cerebrospinal fluid (CSF) drainage has an influence on cerebral perfusion pressure (CPP) and the extent of EBI after aSAH.
Patients with aSAH and indication for ICP-monitoring admitted to our center between 2012 and 2020 were retrospectively included. EBI was categorized based on intracranial blood burden, persistent loss of consciousness, and SEBES (Subarachnoid Hemorrhage Early Brain Edema Score) score on the third day after ictus. The draining CSF and vital signs such as ICP and CPP were documented daily.
90 out of 324 eligible aSAH patients (28%) were included. The mean age was 54.2 ± 11.9 years. DHC was performed in 24% (22/90) of patients. Mean CSF drainage within 72 h after ictus was 168.5 ± 78.5 ml. A higher CSF drainage within 72 h after ictus correlated with a less severe EBI and a less frequent need for DHC (r=-0.33, p = 0.001) and with a higher mean CPP on day 3 after ictus (r = 0.2351, p = 0.02).
A more pronounced CSF drainage in the first 3 days of aSAH was associated with higher CPP and a less severe course of EBI and required less frequently a DHC. These results support the hypothesis that an early and pronounced CSF drainage may facilitate blood clearance and positively influence the course of EBI.
伴有难治性颅内压升高（ICP）的进行性脑水肿，需要进行去骨瓣减压术（DHC），这是蛛网膜下腔出血（aSAH）后早期脑损伤（EBI）的严重表现。本研究旨在探讨更显著的脑脊液（CSF）引流是否对 aSAH 后脑灌注压（CPP）和 EBI 的程度有影响。
回顾性纳入 2012 年至 2020 年期间因 ICP 监测指征而入住我院的 aSAH 患者。根据颅内血容量、持续意识丧失和发病后第三天的 SEBES（蛛网膜下腔出血早期脑水肿评分）评分，将 EBI 分为几类。每天记录引流 CSF 和生命体征，如 ICP 和 CPP。
324 例符合条件的 aSAH 患者中，90 例（28%）被纳入。患者的平均年龄为 54.2±11.9 岁。24%（22/90）的患者行 DHC。发病后 72 小时内的平均 CSF 引流量为 168.5±78.5ml。发病后 72 小时内 CSF 引流量较高与 EBI 程度较轻、DHC 需求较少相关（r=-0.33，p=0.001），与发病后第 3 天 CPP 较高相关（r=0.2351，p=0.02）。
aSAH 后前 3 天更显著的 CSF 引流与更高的 CPP 和 EBI 较轻的病程相关，且较少需要进行 DHC。这些结果支持了早期和显著的 CSF 引流可能促进血液清除并对 EBI 病程产生积极影响的假说。
