Kim Junhyung, Kim Sohyun, Jang Chang Ki, Han Hyun Jin, Park Keun Young, Kim Jung-Jae, Kim Yong Bae, Oh Jiwoong
Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Physiology, Yonsei University College of Medicine, Seoul, Republic of Korea.
Front Neurol. 2025 Aug 6;16:1603869. doi: 10.3389/fneur.2025.1603869. eCollection 2025.
The clinical significance of mastoid effusion (ME) in intensive care unit (ICU) patients has not been well elucidated. Recently, an association between ME and intracranial pressure (ICP) has been reported. We aimed to investigate the clinical implications of ME occurrence in the management of aneurysmal subarachnoid hemorrhage (aSAH) patients and its association with their prognosis.
Data from patients aged > 18 years who were treated for aSAH in a single institution between January 2020 and December 2022 were retrospectively reviewed. Brain CT or MRI images obtained within the first 14 days after the onset of SAH were evaluated for the presence of ME, which is defined as either opacification or an air-fluid level in the mastoid air cells. We examined the patients' demographic information, neurological and medical status at admission, aneurysm and treatment characteristics, and clinical outcomes. We then analyzed how these factors were associated with the occurrence of ME.
A total of 114 patients were included in the study. ME was observed in 40 patients (34.5%) within the first 14 days, occurring at a mean of 5.0 ± 3.5 days after the onset of SAH. In multivariate analysis, patients with ME were found to have a higher incidence of tracheostomy (odds ratio [OR] 10.034, = 0.024), radiologic vasospasm (OR 4.987, = 0.018), a higher APACHE II score (OR 1.138, = 0.013), and poor clinical outcomes (OR 4.289, = 0.041), defined as modified Rankin Scale score > 2 at 90 days. Poor clinical outcomes were independently associated with ME (OR 5.003, = 0.006).
This study demonstrated that ME was observed in 34.5% of aSAH patients and was associated with poor clinical outcomes. ME may serve as a simple and useful prognostic indicator for predicting poor outcomes in aSAH patients.
重症监护病房（ICU）患者中耳乳突积液（ME）的临床意义尚未得到充分阐明。最近，有报道称ME与颅内压（ICP）之间存在关联。我们旨在研究ME的发生在动脉瘤性蛛网膜下腔出血（aSAH）患者管理中的临床意义及其与预后的关系。
回顾性分析2020年1月至2022年12月在单一机构接受aSAH治疗的年龄>18岁患者的数据。评估蛛网膜下腔出血发作后14天内获得的脑部CT或MRI图像中是否存在ME，ME定义为乳突气房内的混浊或气液平面。我们检查了患者的人口统计学信息、入院时的神经和医疗状况、动脉瘤和治疗特征以及临床结局。然后分析这些因素与ME发生的关联。
本研究共纳入114例患者。40例患者（34.5%）在发病后14天内出现ME，平均发生时间为蛛网膜下腔出血发作后5.0±3.5天。多因素分析发现，出现ME的患者气管切开发生率更高（比值比[OR]10.034，P = 0.024）、放射性血管痉挛发生率更高（OR 4.987，P = 0.018）、急性生理与慢性健康状况评分系统（APACHE II）得分更高（OR 1.138，P = 0.013），且临床结局较差（OR 4.289，P = 0.041），临床结局较差定义为90天时改良Rankin量表评分>2。临床结局较差与ME独立相关（OR 5.003，P = 0.006）。
本研究表明，34.5%的aSAH患者出现ME，且与不良临床结局相关。ME可能是预测aSAH患者不良结局的一个简单且有用的预后指标。
