Ventriculoperitoneal shunting after aneurysmal subarachnoid hemorrhage: Analysis of the indications, complications, and outcome with a focus on patients with borderline ventriculomegaly
Ventriculoperitoneal shunting after aneurysmal subarachnoid hemorrhage: Analysis of the indications, complications, and outcome with a focus on patients with borderline ventriculomegaly
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DOI：
10.1227/01.neu.0000317310.62073.b2
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发表时间：
2008-03-01
期刊：
影响因子：
4.8
通讯作者：
Spetzler, Robert F.
中科院分区：
文献类型：
--
作者：
Little, Andrew S.;Zabramski, Joseph M.;Spetzler, Robert F.
目的：本研究的目的是调查蛛网膜下腔出血后脑室腹膜分流术 (VPS) 患者的危险因素、适应症、并发症和结局，并确定一个符合未来前瞻性研究的亚组，旨在阐明放置 VPS 的指征。 方法：对 236 例前瞻性评估的蛛网膜下腔出血患者的临床特征和 6 个月的随访进行分析。脑积水是通过分流时计算机断层扫描测量的相对双尾状指数（RBCI）来估计的。根据心室大小将患者分为三组：第 1 组包括 121 名脑室较小的患者 (RBCI < 1.0)，第 2 组包括 88 名心室大小处于临界值的患者 (RBCI 1.0-1.4)，第 3 组包括 27 名脑室明显增大的患者 (RBCI > 1.4)。 结果：最初，86 名患者 (36%) 接受了脑室腹腔手术分流：第 1 组 19 例（16%），第 2 组 43 例（49%），第 3 组 24 例（90%）。不同组别放置 VPS 的指征、风险因素和结果显着不同。 4 名患者（最初未分流的患者中的 3%）出现了需要 VPS 的迟发性脑积水，其中包括第 2 组中的一名患者 (2%)。 6个月分流并发症发生率为13%。对第 2 组患者的评估表明，功能状态是选择分流候选者的一个重要因素，接受分流的患者和未分流的患者在随访期间表现出功能状态的改善。 结论：虽然我们目前对出血后脑积水使用主动分流模式，但本报告表明，对脑室大小处于临界值（即 RBCI 为 1.0-1.4）且正常的患者采取保守方法颅内压应通过前瞻性随机试验进行评估。
OBJECTIVE: The goals of this study were to investigate the risk factors, indications, complications, and outcome for patients with ventriculoperitoneal shunts (VPSs) after subarachnoid hemorrhage and to define a subgroup eligible for future prospective studies designed to clarify indications for placement of a VPS.METHODS: Clinical characteristics of 236 prospectively evaluated patients with subarachnoid hemorrhage and 6 months of follow-up were analyzed. Hydrocephalus was estimated by the relative bicaudate index (RBCI) measured on computed tomographic scans at the time of shunting. Patients were divided into three groups by ventricle size: Group 1 included 121 patients with small ventricles (RBCI < 1.0), Group 2 included 88 patients with borderline ventricle size (RBCI 1.0-1.4), and Group 3 included 27 patients with markedly enlarged ventricles (RBCI > 1.4).RESULTS: Initially, 86 patients (36%) underwent ventriculoperitoneal shunting: 19 in Group 1 (16%), 43 in Group 2 (49%), and 24 in Group 3 (90%). Indications for placement of a VPS, risk factors, and outcome differed markedly by group. Four patients (3% of those not initially shunted) developed delayed hydrocephalus requiring a VPS, including one in Group 2 (2%). The 6-month shunt complication rate was 13%. Evaluation of patients in Group 2 indicated that functional status was an important factor in selecting candidates for shunting, and that patients receiving shunts and shunt-free patients demonstrated improvement in functional status during follow-up.CONCLUSION: Although we currently use a proactive shunting paradigm for posthemorrhagic hydrocephalus, this report demonstrates that a conservative approach to patients with borderline ventricle size (i.e., RBCI of 1.0-1.4) and normal intracranial pressure should be evaluated in a prospective randomized trial.