PDF(Pubmed)
Abstract：
Hydrocephalus is one of the major complications of aneurysmal subarachnoid haemorrhage (aSAH). In the acute setting, an external ventricular drain (EVD) is used for early management. A cisternal drain (CD) coupled with the micro-surgical opening of basal cisterns can be an alternative when the aneurysm is clipped. Chronic hydrocephalus after aSAH is managed with ventriculo-peritoneal (VP) shunt, a procedure associated with a wide range of complications. The aim of this study is to analyse the impact of micro-surgical opening of basal cisterns coupled with CD on the incidence of VP shunt, compared to patients treated with EVD.
The authors conducted a retrospective review of 89 consecutive cases of patients with aSAH treated surgically and endovascularly with either EVD or CD between January 2009 and September 2021. Patients were stratified into two groups: Group 1 included patients with EVD, Group 2 included patients with CD. Subgroup analysis with only patients treated surgically was also performed. We compared their baseline characteristics, clinical outcomes and shunting rates.
There were no statistically significant differences between the two groups in terms of epidemiological characteristics, WFNS score, Fisher scale, presence of intraventricular hemorrhage (IVH), acute hydrocephalus, postoperative meningitis or of clinical outcomes at last follow-up. Cisternostomy with CD (Group 2) was associated with a statistically significant reduction in VP-shunt compared with the use of an EVD (Group 1) (9.09% vs 53.78%; p < 0.001). This finding was confirmed in our subgroup analysis, as among patients with a surgical clipping, the rate of VP shunt was 43.7% for the EVD group and 9.5% for the CD group (p = 0.02).
Cisternostomy with CD may reduce the rate of shunt-dependent hydrocephalus. Cisternostomy allows the removal of subarachnoid blood, thereby reducing arachnoid inflammation and fibrosis. CD may enhance this effect, thus resulting in lower rates of chronic hydrocephalus.
The authors conducted a retrospective review of 89 consecutive cases of patients with aSAH treated surgically and endovascularly with either EVD or CD between January 2009 and September 2021. Patients were stratified into two groups: Group 1 included patients with EVD, Group 2 included patients with CD. Subgroup analysis with only patients treated surgically was also performed. We compared their baseline characteristics, clinical outcomes and shunting rates.
There were no statistically significant differences between the two groups in terms of epidemiological characteristics, WFNS score, Fisher scale, presence of intraventricular hemorrhage (IVH), acute hydrocephalus, postoperative meningitis or of clinical outcomes at last follow-up. Cisternostomy with CD (Group 2) was associated with a statistically significant reduction in VP-shunt compared with the use of an EVD (Group 1) (9.09% vs 53.78%; p < 0.001). This finding was confirmed in our subgroup analysis, as among patients with a surgical clipping, the rate of VP shunt was 43.7% for the EVD group and 9.5% for the CD group (p = 0.02).
Cisternostomy with CD may reduce the rate of shunt-dependent hydrocephalus. Cisternostomy allows the removal of subarachnoid blood, thereby reducing arachnoid inflammation and fibrosis. CD may enhance this effect, thus resulting in lower rates of chronic hydrocephalus.
摘要：
背景：脑积水是动脉瘤性蛛网膜下腔出血（aSAH）的主要并发症之一。在急性环境中，外部心室引流（EVD）用于早期管理。当动脉瘤被夹住时，与基底水箱的显微外科开口相结合的水箱引流（CD）可以是一种选择。aSAH后的慢性脑积水采用脑室-腹膜（VP）分流术治疗，与各种并发症相关的手术。这项研究的目的是分析基底池的显微外科开放与CD对VP分流发生率的影响。与接受EVD治疗的患者相比。
方法：作者对2009年1月至2021年9月期间经手术和血管内治疗EVD或CD的89例aSAH患者进行了回顾性分析。将患者分为两组：第1组包括EVD患者，第2组包括患有CD的患者。还进行了仅手术治疗的患者的亚组分析。我们比较了它们的基线特征，临床结果和分流率。
结果:两组在流行病学特征方面无统计学差异,WFNS得分,费希尔量表，脑室内出血（IVH）的存在，急性脑积水,术后脑膜炎或末次随访时的临床结局。与使用EVD（第1组）（9.09%vs.53.78%；p<0.001）相比，CD（第2组）与VP分流的统计学显着降低相关。这一发现在我们的亚组分析中得到了证实，就像手术夹闭的患者一样，VP分流率EVD组为43.7%,CD组为9.5%(p=0.02).
结论：闭路造口术伴CD可降低分流依赖性脑积水的发生率。胸壁造口术可以去除蛛网膜下腔血液，从而减少蛛网膜炎症和纤维化。CD可以增强这种效果，从而导致慢性脑积水的发生率较低。
方法：作者对2009年1月至2021年9月期间经手术和血管内治疗EVD或CD的89例aSAH患者进行了回顾性分析。将患者分为两组：第1组包括EVD患者，第2组包括患有CD的患者。还进行了仅手术治疗的患者的亚组分析。我们比较了它们的基线特征，临床结果和分流率。
结果:两组在流行病学特征方面无统计学差异,WFNS得分,费希尔量表，脑室内出血（IVH）的存在，急性脑积水,术后脑膜炎或末次随访时的临床结局。与使用EVD（第1组）（9.09%vs.53.78%；p<0.001）相比，CD（第2组）与VP分流的统计学显着降低相关。这一发现在我们的亚组分析中得到了证实，就像手术夹闭的患者一样，VP分流率EVD组为43.7%,CD组为9.5%(p=0.02).
结论：闭路造口术伴CD可降低分流依赖性脑积水的发生率。胸壁造口术可以去除蛛网膜下腔血液，从而减少蛛网膜炎症和纤维化。CD可以增强这种效果，从而导致慢性脑积水的发生率较低。
