Ma Yuehui, Bu Linghao, Wu Dengchang, Wang Kang, Zhou Hengjun
Department of Neurosurgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, China.
Department of Neurology, The First Affiliated Hospital, School of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, China.
Sci Rep. 2025 Jan 13;15(1):1842. doi: 10.1038/s41598-025-86060-5.
This study explored the risk factors associated with hydrocephalus incidence and evaluated the effectiveness of surgical treatments in managing this condition. Patients with PBSH were retrospectively evaluated, identifying clinical and radiological characteristics. A multivariate logistic regression model was used for analyses. Of the 169 patients studied, 77 developed hydrocephalus. Midbrain hemorrhage, tegmental pons hemorrhage, disappearance of annular cisterna, combined cerebellar and intraventricular hematoma increased the risk of hydrocephalus (p < 0.05). A linear relationship was found between hematoma volume and hydrocephalus, with a volume > 6.1 mL associated with a higher risk. Patients with ≥ 2 the following factors: multiple hematoma sites, intraventricular hematoma, or hematoma volume > 6.1 mL, had a significantly increased risk of hydrocephalus. Forty-seven patients received surgical treatments including stereotactic puncture drainage of hematoma (SPDH) or external ventricular drainage (EVD). Both SPDH and EVD were effective in treating hydrocephalus (p < 0.001). The combination of SPDH and EVD showed the greatest benefit (p < 0.001); 30-day mortality and de-ventilator rates in the surgical group were significantly different from the non-surgical group. This finding provides valuable insights for early surgical intervention in patients with PBSH.
本研究探讨了与脑积水发生率相关的危险因素，并评估了手术治疗在处理该病症中的有效性。对原发性脑干出血（PBSH）患者进行回顾性评估，确定其临床和影像学特征。采用多因素逻辑回归模型进行分析。在169例研究患者中，77例发生了脑积水。中脑出血、脑桥被盖部出血、环池消失、合并小脑和脑室内血肿增加了脑积水的风险（p < 0.05）。发现血肿体积与脑积水之间存在线性关系，血肿体积>6.1 mL时风险更高。具有以下≥2个因素的患者：多个血肿部位、脑室内血肿或血肿体积>6.1 mL，发生脑积水的风险显著增加。47例患者接受了手术治疗，包括血肿立体定向穿刺引流（SPDH）或脑室外引流（EVD）。SPDH和EVD在治疗脑积水方面均有效（p < 0.001）。SPDH和EVD联合使用显示出最大益处（p < 0.001）；手术组的30天死亡率和脱机率与非手术组有显著差异。这一发现为PBSH患者的早期手术干预提供了有价值的见解。
