Larsson Lydia, Vedung Fredrik, Virhammar Johan, Ronne-Engström Elisabeth, Lewén Anders, Enblad Per, Svedung Wettervik Teodor
Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden.
Department of Medical Sciences, Section of Neurology, Uppsala University, Uppsala, Sweden.
World Neurosurg. 2025 Apr;196:123806. doi: 10.1016/j.wneu.2025.123806. Epub 2025 Mar 13.
The main aim was to determine the incidence, risk factors, clinical phenotypes, and response to shunt surgery in chronic, shunt-dependent hydrocephalus (SDHC) after aneurysmal subarachnoid hemorrhage (aSAH).
In this observational, single-center study, 849 aSAH patients treated at Uppsala University Hospital between 2008-2018 were included. Variables on demography, injury severity, treatments, chronic hydrocephalus presentation, and outcome were evaluated.
In total, 107 (13%) patients were treated with a shunt due to SDHC. In multivariate logistic regressions, risk factors for SDHC were worse neurologic (World Federation of Neurosurgical Societies) grade, larger ventricles (Evans index) at admission, the need to insert an external ventricular drain (EVD), decompressive craniectomy, and complications with meningitis. Six different SDHC phenotypes were identified: impeded neurological recovery (55%), Hakim-Adams syndrome (17%), high-pressure symptoms (13%), failed EVD removal (8%), external brain herniation after decompressive craniectomy (DC; 6%), and subdural hygroma (1%). The former 3 groups significantly improved in modified Rankin Scale (mRS) and 87%-100% exhibited subjective symptomatic relief. There was no significant change in mRS for the latter 3 groups, but 60%-100% experienced some subjective relief postoperatively.
Chronic SDHC was a common complication after aSAH, particularly in patients with severe primary brain injury, acute hydrocephalus, and treatment-related factors. The condition presents with distinct clinical phenotypes, which may influence treatment response. Recognizing these phenotypes could aid in optimizing patient selection and expectations for shunt surgery outcomes.
主要目的是确定动脉瘤性蛛网膜下腔出血（aSAH）后慢性、依赖分流的脑积水（SDHC）的发病率、危险因素、临床表型以及分流手术的反应。
在这项单中心观察性研究中，纳入了2008年至2018年在乌普萨拉大学医院接受治疗的849例aSAH患者。评估了人口统计学、损伤严重程度、治疗、慢性脑积水表现和结局等变量。
共有107例（13%）患者因SDHC接受了分流治疗。在多因素逻辑回归分析中，SDHC的危险因素包括较差的神经功能（世界神经外科联合会分级）、入院时较大的脑室（Evans指数）、需要插入外部脑室引流管（EVD）、减压性颅骨切除术以及脑膜炎并发症。识别出六种不同的SDHC表型：神经功能恢复受阻（55%）、Hakim-Adams综合征（17%）、高压症状（13%）、EVD拔除失败（8%）、减压性颅骨切除术后（DC）脑外疝（6%）和硬膜下积液（1%）。前3组的改良Rankin量表（mRS）有显著改善，87%-100%的患者主观症状缓解。后3组的mRS无显著变化，但60%-100%的患者术后有一定程度的主观缓解。
慢性SDHC是aSAH后的常见并发症，尤其是在有严重原发性脑损伤、急性脑积水和治疗相关因素的患者中。该疾病具有不同的临床表型，这可能会影响治疗反应。认识这些表型有助于优化患者选择和对分流手术结果的预期。
