İsikay Ahmet İlkay, Cekic Efecan, Charehsaz Amin, Uyaniker Zeynep Arzum, Cakmakli Gul Yalcin, Gocmen Rahsan, Hanalioglu Sahin, Elibol Bulent
Department of Neurosurgery, Hacettepe University, Ankara, Turkey.
Department of Neurology, Hacettepe University, Ankara, Türkiye.
Neurosurg Rev. 2025 Mar 17;48(1):304. doi: 10.1007/s10143-025-03459-4.
Idiopathic normal pressure hydrocephalus (iNPH) primarily affects older patients. Ventriculoperitoneal (VP) shunt surgery is a standard treatment. Many iNPH patients have high cardiovascular risks and require aspirin (ASA) therapy to prevent thromboembolic events. Discontinuing ASA increases the risk of these events. This study evaluates the impact of perioperative ASA use on hemorrhagic complications in iNPH patients undergoing VP shunt surgery.
This retrospective cohort study included patients who underwent VP shunt surgery for iNPH from January 2020 to September 2024. Patients were divided into two groups based on perioperative ASA use: no ASA (n = 50) and ASA continued (n = 51). Data collected included demographics, surgery details, ASA dosage, and indications for ASA use. Primary outcomes were early and late postoperative hemorrhage incidences. Postoperative follow-up included MRI or CT scans at regular intervals (mean ≈ one year). Statistical analyses were performed using SPSS version 23.0, with Chi-square tests and independent samples t-tests or Mann-Whitney U tests used to analyze differences between groups.
The study cohort had 101 patients with a mean age of 69.5 ± 7.6 years, 41.6% female and 58.4% male. Early postoperative hemorrhage occurred in 5% of patients, including epidural (1), intraparenchymal(3), and intraventricular hematoma(1). Late postoperative hemorrhages occurred in 4% of patients ( 4 patients in the no-ASA group), with two cases each of unilateral and bilateral subdural hematoma. No significant differences in hemorrhagic outcomes were observed between the ASA continuation and non-use groups (p = 0.092). The mean follow-up period was 300 days. One patient died in non-ASA group due to neurodegenerative disease.
Perioperative ASA use does not significantly impact the incidence of postoperative hemorrhages in iNPH patients undergoing VP shunt surgery. These findings suggest that ASA can be safely continued without increasing hemorrhagic risks. This is a particularly significant issue for patients with high cardiovascular risk.
特发性正常压力脑积水（iNPH）主要影响老年患者。脑室腹腔（VP）分流手术是一种标准治疗方法。许多iNPH患者有较高的心血管风险，需要阿司匹林（ASA）治疗以预防血栓栓塞事件。停用ASA会增加这些事件的风险。本研究评估围手术期使用ASA对接受VP分流手术的iNPH患者出血并发症的影响。
这项回顾性队列研究纳入了2020年1月至2024年9月因iNPH接受VP分流手术的患者。根据围手术期ASA使用情况将患者分为两组：未使用ASA组（n = 50）和继续使用ASA组（n = 51）。收集的数据包括人口统计学资料、手术细节、ASA剂量以及使用ASA的指征。主要结局是术后早期和晚期出血发生率。术后随访包括定期（平均约一年）进行MRI或CT扫描。使用SPSS 23.0进行统计分析，采用卡方检验以及独立样本t检验或曼-惠特尼U检验分析组间差异。
研究队列中有101例患者，平均年龄为69.5±7.6岁，女性占41.6%，男性占58.4%。5%的患者发生术后早期出血，包括硬膜外血肿（1例）、脑实质内血肿（3例）和脑室内血肿（1例）。4%的患者发生术后晚期出血（未使用ASA组4例患者），单侧和双侧硬膜下血肿各2例。继续使用ASA组和未使用ASA组在出血结局方面未观察到显著差异（p = 0.092）。平均随访期为300天。未使用ASA组有1例患者因神经退行性疾病死亡。
围手术期使用ASA对接受VP分流手术的iNPH患者术后出血发生率无显著影响。这些发现表明，继续使用ASA是安全的，不会增加出血风险。对于心血管风险高的患者而言，这是一个尤为重要的问题。
