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Ma L, Wang W, Zhao Y, Liu M, Ye W, Li X. Application of LRG mechanism in normal pressure hydrocephalus. Heliyon 2024; 10:e23940. [PMID: 38223707 PMCID: PMC10784321 DOI: 10.1016/j.heliyon.2023.e23940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 11/02/2023] [Accepted: 12/15/2023] [Indexed: 01/16/2024] Open
Abstract
Normal pressure hydrocephalus (NPH) is a prevalent type of hydrocephalus, including secondary normal pressure hydrocephalus (SNPH) and idiopathic normal pressure hydrocephalus (INPH). However, its clinical diagnosis and pathological mechanism are still unclear. Leucine-rich α-2 glycoprotein (LRG) is involved in various human diseases, including cancer, diabetes, cardiovascular disease, and nervous system diseases. Now the physiological mechanism of LRG is still being explored. According to the current research results on LRG, we found that the agency of LRG has much to do with the known pathological process of NPH. This review focuses on analyzing the LRG signaling pathways and the pathological mechanism of NPH. According to the collected literature evidence, we speculated that LRG probably be involved in the pathological process of NPH. Finally, based on the mechanism of LRG and NPH, we also summarized the evidence of molecular targeted therapies for future research and clinical application.
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Affiliation(s)
| | | | - Yongqiang Zhao
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Menghao Liu
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Wei Ye
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Xianfeng Li
- Department of Neurosurgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
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2
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Geng Y, Jia J, Liu X, Li T, Liu H, Sun Y, Wang Y. Clinical outcome and prognostic factors of patients with non-traumatic angiography-negative subarachnoid hemorrhage. Front Neurol 2023; 14:1157845. [PMID: 37545726 PMCID: PMC10398389 DOI: 10.3389/fneur.2023.1157845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Purpose The cause of spontaneous subarachnoid hemorrhage (SAH) is unknown in 10% of cases. The aim of this study was to demonstrate the characteristics of patients with angiography-negative subarachnoid hemorrhage (anSAH) and to analyze factors influencing the clinical outcome in patients suffering from anSAH. Methods A retrospective cohort of 75 patients with anSAH [26 perimesencephalic (pmSAH) and 49 non-perimesencephalic SAH (npmSAH)] admitted between January 2016 and June 2022 was included. We analyzed demographic, clinical data and 6-month functional outcomes. Enter regression analysis was performed to identify factors associated with outcomes. Results Unfavorable outcome was achieved in 10 of 75 patients (13.3%). Unfavorable outcome was associated with senior adults (p = 0.008), Hijdra cistern score (HCS) elevation (p = 0.015), long-time lumbar cistern continuous drainage (LCFD; p = 0.029) and hydrocephalus (p = 0.046). The only significant risk factor for unfavorable outcome after npmSAH was the HCS (OR 1.213 (95%CI 1.007-1.462), p = 0.042). Conclusion Our study provides valuable information on both SAH patterns and functional outcome in patients suffering from anSAH and should be taken into consideration during management of these patients.
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Affiliation(s)
- Yibo Geng
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jianwen Jia
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiaoli Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Tong Li
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - He Liu
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yongquan Sun
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yang Wang
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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3
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Hostettler IC, Lange N, Schwendinger N, Ambler G, Hirle T, Frangoulis S, Trost D, Gempt J, Kreiser K, Meyer B, Winter C, Wostrack M. VPS dependency after aneurysmal subarachnoid haemorrhage and influence of admission hyperglycaemia. Eur Stroke J 2023; 8:301-308. [PMID: 37021154 PMCID: PMC10069185 DOI: 10.1177/23969873221147087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/05/2022] [Indexed: 12/31/2022] Open
Abstract
Introduction Hydrocephalus after aneurysmal subarachnoid haemorrhage (aSAH) is a common complication which may lead to insertion of a ventriculoperitoneal shunt (VPS). Our aim is to evaluate a possible influence of specific clinical and biochemical factors on VPS dependency with special emphasis on hyperglycaemia on admission. Patients and methods Retrospective analysis of a monocentric database of aSAH patients. Using univariable and multivariable logistic regression analysis we evaluated factors influencing VPS dependency, with a special focus on hyperglycaemia on blood sample within 24 h of admission, dichotomised at 126 mg/dl. Factors evaluated in the univariable analysis were age, sex, known diabetes, Hunt and Hess grade, Barrow Neurological Institute scale, treatment modality, extra-ventricular drain (EVD) insertion, complications (rebleeding, vasospasm, infarction, decompressive craniectomy, ventriculitis), outcome variables and laboratory parameters (glucose, C-reactive protein, procalcitonin). Results We included 510 consecutive patients treated with acute aSAH requiring a VPS (mean age 58.2 years, 66% were female). An EVD was inserted in 387 (75.9%) patients. In the univariable analysis, VPS dependency was associated with hyperglycaemia on admission (OR 2.56, 95%CI 1.58-4.14, p < 0.001). In the multivariable regression analysis after stepwise backward regression, factors associated with VPS dependency were hyperglycaemia >126 mg/dl on admission (OR 1.93, 95%CI 1.13-3.30, p = 0.02), ventriculitis (OR 2.33, 95%CI 1.33-4.04, p = 0.003), Hunt and Hess grade (overall p-value 0.02) and decompressive craniectomy (OR 2.68, 95%CI 1.55-4.64, p < 0.001). Conclusion Hyperglycaemia on admission was associated with an increased probability of VPS placement. If confirmed, this finding might facilitate treatment of these patients by accelerating insertion of a permanent draining system.
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Affiliation(s)
- Isabel Charlotte Hostettler
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Nicole Lange
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Nina Schwendinger
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Theresa Hirle
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Samira Frangoulis
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dominik Trost
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jens Gempt
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Kornelia Kreiser
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christof Winter
- Institute of Clinical Chemistry and Pathobiochemistry, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Maria Wostrack
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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4
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Elghity A, El Halaby W, Raafat W, Sorour O, Atallah A. Assessment of Sustained Systemic Inflammatory Response Syndrome and CSF Markers as Predictive Values Associated with Shunt-Dependent Hydrocephalus after Aneurysmal Subarachnoid Hemorrhage. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim of the study: This study was conducted to detect incidence and risk factors of shunt-dependent hydrocephalus, including Systemic Inflammatory Response Syndrome.
Patients and methods: After obtaining ethical approval from the research ethics committee of Cairo University, this study was conducted in two phases, phase I in the form of follow up study to detect the incidence of shunt dependent hydrocephalus in patients with ruptured subarachnoid aneurysm then phase II in the form of comparative one to detect the risk factors of acquisition of shunt dependent hydrocephalus and detect the predictive role of SIRS in SDH. The study included 90 patients with ruptured subarachnoid aneurysms followed up in the department of neurosurgery of Cairo university hospital from April 2018 to April 2020.
Results: The incidence of shunt-dependent hydrocephalus was 28% among the studied patients with significant association with high-grade SIRS, Fisher score, Hunt and Hess score, and leukocytosis. The CSF white blood cells and protein were significantly higher in the hydrocephalus group. Also, there was significant hypernatremia among the hydrocephalic group.
Conclusion: Despite the study's analytical design, we observed a link between high fisher, SIRS, hypernatremia, and shunt-dependent hydrocephalus in aneurysmal SAH patients. Serum sodium, CSF WBCs, and protein may all be used to predict HC.
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Achrén A, Raj R, Siironen J, Laakso A, Marjamaa J. Spontaneous angiogram-negative subarachnoid hemorrhage: a retrospective single center cohort study. Acta Neurochir (Wien) 2022; 164:129-140. [PMID: 34853936 PMCID: PMC8761132 DOI: 10.1007/s00701-021-05069-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 11/12/2021] [Indexed: 12/13/2022]
Abstract
Background Spontaneous angiogram-negative subarachnoid hemorrhage (SAH) is considered a benign illness with little of the aneurysmal SAH-related complications. We describe the clinical course, SAH-related complications, and outcome of patients with angiogram-negative SAH. Methods We retrospectively reviewed all adult patients admitted to a neurosurgical intensive care unit during 2004–2018 due to spontaneous angiogram-negative SAH. Our primary outcome was a dichotomized Glasgow Outcome Scale (GOS) at 3 months. We assessed factors that associated with outcome using multivariable logistic regression analysis. Results Of the 108 patients included, 84% had a favorable outcome (GOS 4–5), and mortality was 5% within 1 year. The median age was 58 years, 51% were female, and 93% had a low-grade SAH (World Federation of Neurosurgical Societies grading I–III). The median number of angiograms performed per patient was two. Thirty percent of patients showed radiological signs of acute hydrocephalus, 28% were acutely treated with an external ventricular drain, 13% received active vasospasm treatment and 17% received a permanent shunt. In the multivariable logistic regression model, only acute hydrocephalus associated with unfavorable outcome (odds ratio = 4.05, 95% confidence interval = 1.05–15.73). Two patients had a new bleeding episode. Conclusion SAH-related complications such as hydrocephalus and vasospasm are common after angiogram-negative SAH. Still, most patients had a favorable outcome. Only acute hydrocephalus was associated with unfavorable outcome. The high rate of SAH-related complications highlights the need for neurosurgical care in these patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00701-021-05069-7.
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Daou BJ, Khalsa SSS, Anand SK, Williamson CA, Cutler NS, Aaron BL, Srinivasan S, Rajajee V, Sheehan K, Pandey AS. Volumetric quantification of aneurysmal subarachnoid hemorrhage independently predicts hydrocephalus and seizures. J Neurosurg 2021; 135:1155-1163. [PMID: 33545677 DOI: 10.3171/2020.8.jns201273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/10/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Hydrocephalus and seizures greatly impact outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH); however, reliable tools to predict these outcomes are lacking. The authors used a volumetric quantitative analysis tool to evaluate the association of total aSAH volume with the outcomes of shunt-dependent hydrocephalus and seizures. METHODS Total hemorrhage volume following aneurysm rupture was retrospectively analyzed on presentation CT imaging using a custom semiautomated computer program developed in MATLAB that employs intensity-based k-means clustering to automatically separate blood voxels from other tissues. Volume data were added to a prospectively maintained aSAH database. The association of hemorrhage volume with shunted hydrocephalus and seizures was evaluated through logistic regression analysis and the diagnostic accuracy through analysis of the area under the receiver operating characteristic curve (AUC). RESULTS The study population comprised 288 consecutive patients with aSAH. The mean total hemorrhage volume was 74.9 ml. Thirty-eight patients (13.2%) developed seizures. The mean hemorrhage volume in patients who developed seizures was significantly higher than that in patients with no seizures (mean difference 17.3 ml, p = 0.01). In multivariate analysis, larger hemorrhage volume on initial CT scan and hemorrhage volume > 50 ml (OR 2.81, p = 0.047, 95% CI 1.03-7.80) were predictive of seizures. Forty-eight patients (17%) developed shunt-dependent hydrocephalus. The mean hemorrhage volume in patients who developed shunt-dependent hydrocephalus was significantly higher than that in patients who did not (mean difference 17.2 ml, p = 0.006). Larger hemorrhage volume and hemorrhage volume > 50 ml (OR 2.45, p = 0.03, 95% CI 1.08-5.54) were predictive of shunt-dependent hydrocephalus. Hemorrhage volume had adequate discrimination for the development of seizures (AUC 0.635) and shunted hydrocephalus (AUC 0.629). CONCLUSIONS Hemorrhage volume is an independent predictor of seizures and shunt-dependent hydrocephalus in patients with aSAH. Further evaluation of aSAH quantitative volumetric analysis may complement existing scales used in clinical practice and assist in patient prognostication and management.
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Affiliation(s)
- Badih J Daou
- 1Department of Neurosurgery, University of Michigan, Ann Arbor; and
| | | | | | | | - Noah S Cutler
- 1Department of Neurosurgery, University of Michigan, Ann Arbor; and
| | - Bryan L Aaron
- 1Department of Neurosurgery, University of Michigan, Ann Arbor; and
| | | | | | - Kyle Sheehan
- 1Department of Neurosurgery, University of Michigan, Ann Arbor; and
| | - Aditya S Pandey
- 1Department of Neurosurgery, University of Michigan, Ann Arbor; and
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7
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Brain-Specific Biomarkers as Mortality Predictors after Aneurysmal Subarachnoid Haemorrhage. J Clin Med 2020; 9:jcm9124117. [PMID: 33419282 PMCID: PMC7766120 DOI: 10.3390/jcm9124117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/05/2020] [Accepted: 12/18/2020] [Indexed: 01/14/2023] Open
Abstract
Aneurysmal subarachnoid haemorrhage (aSAH) is a serious condition with a high mortality and high permanent disability rate for those who survive the initial haemorrhage. The purpose of this study was to investigate markers specific to the central nervous system as potential in-hospital mortality predictors after aSAH. In patients with an external ventricular drain, enolase, S100B, and GFAP levels were measured in the blood and cerebrospinal fluid (CSF) on days 1, 2, and 3 after aSAH. Compared to survivors, non-survivors showed a significantly higher peak of S100B and enolase levels in the blood (S100B: 5.7 vs. 1.5 ng/mL, p = 0.031; enolase: 6.1 vs. 1.4 ng/mL, p = 0.011) and the CSF (S100B: 18.3 vs. 0.9 ng/mL, p = 0.042; enolase: 109.2 vs. 6.1 ng/mL, p = 0.015). Enolase showed the highest level of predictability at 1.8 ng/mL in the blood (AUC of 0.873) and 80.0 ng/mL in the CSF (AUC of 0.889). The predictive ability of S100B was also very good with a threshold of 5.7 ng/mL in the blood (AUC 0.825) and 4.5 ng/mL in the CSF (AUC 0.810). In conclusion, enolase and S100B, but not GFAP, might be suitable as biomarkers for the early prediction of in-hospital mortality after aSAH.
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Zahedi S, Hudson M, Jin X, Garling RJ, Gluski J, Nowak C, Marupudi NI, Begeman P, Harris CA. Investigation of ventriculoperitoneal shunt disconnection for hydrocephalus treatment. J Neurosurg Pediatr 2020; 27:125-130. [PMID: 33186903 PMCID: PMC8116348 DOI: 10.3171/2020.6.peds20454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/30/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This investigation is aimed at gaining a better understanding of the factors that lead to mechanical failure of shunts used for the treatment of hydrocephalus, including shunt catheter-valve disconnection and shunt catheter fracture. METHODS To determine the root cause of mechanical failure, the authors created a benchtop mechanical model to mimic mechanical stressors on a shunt system. To test shunt fracture, cyclical loading on the catheter-valve connection site was tested with the shunt catheter held perpendicular to the valve. Standard methods were used to secure the catheter and valves with Nurolon. These commercial systems were compared to integrated catheters and valves (manufactured as one unit). To test complete separation/disconnection of the shunt catheter and valve, a parallel displacement test was conducted using both Nurolon and silk sutures. Finally, the stiffness of the catheters was assessed. All mechanical investigations were conducted on shunts from two major shunt companies, assigned as either company A or company B. RESULTS Cyclical loading experiments found that shunts from company B fractured after a mean of 4936 ± 1725 cycles (95% CI 2990-6890 cycles), while those of company A had not failed after 8000 cycles. The study of parallel displacement indicated complete disconnection of company B's shunt catheter-valve combination using Nurolon sutures after being stretched an average 32 ± 5.68 mm (95% CI 25.6-38.4 mm), whereas company A's did not separate using either silk or Nurolon sutures. During the stiffness experiments, the catheters of company B had statistically significantly higher stiffness of 13.23 ± 0.15 N compared to those of company A, with 6.16 ± 0.29 N (p < 0.001). CONCLUSIONS Mechanical shunt failure from shunt catheter-valve disconnection or fracture is a significant cause of shunt failure. This study demonstrates, for the first time, a correlation between shunt catheters that are less mechanically stiff and those that are less likely to disconnect from the valve when outstretched and are also less likely to tear when held at an angle from the valve outlet. The authors propose an intervention to the standard of care wherein less stiff catheters are trialed to reduce disconnection.
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Affiliation(s)
- Sulmaz Zahedi
- College of Medicine, Central Michigan University, Mount Pleasant, Michigan
| | - Miles Hudson
- School of Medicine, Wayne State University, Detroit, Michigan
| | - Xin Jin
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan
| | | | - Jacob Gluski
- School of Medicine, Wayne State University, Detroit, Michigan
| | - Caden Nowak
- School of Medicine, Wayne State University, Detroit, Michigan
| | - Neena I. Marupudi
- School of Medicine, Wayne State University, Detroit, Michigan,Department of Neurosurgery, Wayne State University, Detroit, Michigan
| | - Paul Begeman
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan
| | - Carolyn A. Harris
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan,Department of Neurosurgery, Wayne State University, Detroit, Michigan,Department of Chemical Engineering and Material Science, Wayne State University, Detroit, Michigan
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Alimohammadi E, Bagheri SR, Hadidi H, Habibi S, Amiri A, Moradi S, Abdi A. Factors Associated with the Need for Ventriculoperitoneal Shunting in Patients with Spontaneous Intracerebral Hemorrhage Requiring Emergency Cerebrospinal Fluid Diversion. INDIAN JOURNAL OF NEUROSURGERY 2020. [DOI: 10.1055/s-0040-1710149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Abstract
Introduction Intracerebral hemorrhage (ICH) is a serious medical condition that is frequently complicated by acute hydrocephalus, necessitating emergency cerebrospinal fluid (CSF) diversion in a subset of patients, ultimately requiring long-term treatment via placement of permanent ventricular shunts. The present study aimed to determine factors associated with the need for permanent ventricular shunt placement in these patients.
Methods A total of 309 consecutive patients who underwent emergent CSF diversion with external ventricular drain (EVD) as a treatment for ICH between July 2009 and July 2018 were studied retrospectively to assess the factors that might be correlated with shunt-dependent chronic hydrocephalus. A binary logistic regression model was designed to identify independent related factors of shunt-dependent hydrocephalus after ICH.
Results Of 309 patients included in this study, 102 (33.00%) required permanent ventricular CSF shunting before discharge. In univariate analysis, age,ventriculitis, ICP elevation >30 mm Hg, ICH evacuation, the Graeb score, days of EVD in place, and CSF protein levels were significantly associated with the requirement for permanent CSF diversion (p < 0.05). The age and ICH evacuation were protective variables and the ventriculoperitoneal (VP) shunt possibility was reduced by 22.6 and 63.5%, respectively.
Conclusion Our results showed that higher Graeb score, ICP elevation >30 mm Hg, more days of EVD in place, and higher CSF protein levels were associated with permanent CSF diversion in these patients. Advanced age and ICH evacuation decreased the possibility of VP shunting in our study.These factors may help in predicting which patients will need permanent CSF diversion and could ultimately lead to improvements in the management of these patients.
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Affiliation(s)
- Ehsan Alimohammadi
- Department of Neurosurgery, Kermanshah University of Medical Sciences, Imam Reza Hospital, Kermanshah, Iran
| | - Seyed Reza Bagheri
- Department of Neurosurgery, Kermanshah University of Medical Sciences, Imam Reza Hospital, Kermanshah, Iran
| | - Homa Hadidi
- Kermanshah University of Medical Sciences, Imam Reza Hospital, Kermanshah, Iran
| | - Shabnam Habibi
- Clinical Research Development Center, Kermanshah University of Medical Sciences, Imam Reza Hospital, Kermanshah, Islamic Republic of Iran
| | - Akram Amiri
- Kermanshah University of Medical Sciences, Imam Reza Hospital, Kermanshah, Iran
| | - Sahar Moradi
- Kermanshah University of Medical Sciences, Imam Reza Hospital, Kermanshah, Iran
| | - Alireza Abdi
- Department of Nursing, Kermanshah University of Medical Sciences, Imam Reza Hospital, Kermanshah, Iran
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Yee SV, Ghani AR, Raffiq A. Review of CHESS Score in SAH Patients in Local Malaysian Population. J Neurosci Rural Pract 2020; 11:113-118. [PMID: 32140013 PMCID: PMC7055635 DOI: 10.1055/s-0039-3402573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background
Chronic hydrocephalus caused by subarachnoid hemorrhage is a reversible and treatable condition. To date, existing clinical scores for predicting the development of posthemorrhagic hydrocephalus are few and difficult to apply in the clinical settings. Chronic hydrocephalus ensuing subarachnoid hemorrhage score (CHESS) was first published in 2016. Although it showed promising results, no external validation has been done outside Europe. We designed this study to validate the accuracy and reliability of CHESS score and to also look for other factors that may cause posthemorrhagic shunt dependent hydrocephalus.
Objectives
This study is to determine the reliability of CHESS score and to look for other parameters with predictive value in patients with shunt-dependent posthemorrhagic hydrocephalus.
Results
Thirty-one percent of the studied population developed shunt-dependent hydrocephalus (
n
= 41). CHESS score showed an odds ratio (OR) of 2.184 with
p
-value < 0.001 and two other risk factors were found to be strongly related to develop shunt-dependent hydrocephalus, that is, early infarct in computed tomography (CT) brain (OR = 0.182;
p
-value = 0.004) and Fisher’s grade > 3 (OR = 1.986;
p
-value = 0.047). The sensitivity and specificity for CHESS score in this cohort population showed a sensitivity of 73.2% and specificity of 93.3%. The area under the curve for CHESS score in our cohort is 0.922.
Conclusion
CHESS score is a reliable tool in early prediction of shunt-dependent hydrocephalus post subarachnoid hemorrhage.
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Affiliation(s)
- Sze-Voon Yee
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.,Department of Neurosurgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Abdul Rahman Ghani
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Azman Raffiq
- Department of Neurosurgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
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Hao X, Wei D. The risk factors of shunt-dependent hydrocephalus after subarachnoid space hemorrhage of intracranial aneurysms. Medicine (Baltimore) 2019; 98:e15970. [PMID: 31277089 PMCID: PMC6635240 DOI: 10.1097/md.0000000000015970] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Shunt-dependent hydrocephalus is a common complication of aneurysmal subarachnoid hemorrhage (aSAH) which indicated intensive care unit stay and unfavorable outcome. Our aim is to study the risk factors of shunt-dependent hydrocephalus after aneurysmal subarachnoid space hemorrhage. Patients with intracranial aneurysms treated in our department from January 2014 to October 2018 were included in the study. Patients' age, gender, history of hypertension and diabetes, location of aneurysms, Glasgow coma scale (GCS) score, Hunt-Hess grading, intraventricular hemorrhage, therapeutic option, shunt placement, clinical outcome, length of stay were analyzed. The follow-up period was 1 to 5 years. Statistics included Chi-squared, Student t test, 1-way analysis of variance, Pearson correlation coefficient, and multivariate logistic regression. About 845 cases with intracranial aneurysms treated in our department were included in the study. The mean age was 52.19 ± 9.51 years and the sex ratio was 317/528. About 14.3% (121/845) of the patients developed shunt-dependent hydrocephalus in the follow-up period. According to our results, older than 60, Hunt-Hess grading, GCS, coma, posterior circulation aneurysm, external ventricular drainage, and decompress craniotomy were risk factors of shunt dependency (P < .05). Moreover, older than 60, GCS 3 to 8, Hunt-Hess 3 to 5, and posterior circulation aneurysm were the independent risk factors of shunt dependency. Moreover, shunt dependency was related to longer hospital stay and unfavorable outcome (P < .05). In conclusion, patients older than 60, GCS 3 to 8, Hunt-Hess 3 to 5, and posterior circulation aneurysm need more strict observation and longer follow-up. Timely and appropriate treatment may benefit patients in recovery, while further exploration is still needed in the future.
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Affiliation(s)
- Xu Hao
- Department of Neurosurgery, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui
| | - Ding Wei
- Department of Neurosurgery, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Ho YN, Hsu SY, Lin YT, Cheng FC, Lin YJ, Tsai NW, Lu CH, Wang HC. Predictive factors of neurologic deterioration in patients with spontaneous cerebellar hemorrhage: a retrospective analysis. BMC Neurol 2019; 19:81. [PMID: 31043163 PMCID: PMC6495504 DOI: 10.1186/s12883-019-1312-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 04/18/2019] [Indexed: 01/06/2023] Open
Abstract
Background Cerebellar hemorrhage is a potentially life-threatening condition and neurologic deterioration during hospitalization could lead to severe disability and poor outcome. Finds out the factors influencing neurologic deterioration during hospitalization is essential for clinical decision-making. Methods One hundred fifty-five consecutive patients who suffered a first spontaneous cerebellar hemorrhage (SCH) were evaluated in this 10-year retrospective study. This study aimed to identify potential clinical, radiological and clinical scales risk factors for neurologic deterioration during hospitalization and outcome at discharge. Results Neurologic deterioration during hospitalization developed in 17.4% (27/155) of the patient cohort. Obliteration of basal cistern (p≦0.001) and hydrocephalus (p≦0.001) on initial brain computed tomography (CT), median Glasgow Coma Scale (GCS) score at presentation (p≦0.001) and median intracerebral hemorrhage (ICH) score (P≦0.001) on admission were significant factors associated with neurologic deterioration. Stepwise logistic regression analysis showed that patients with obliteration of basal cistern on initial brain CT scan had an odds ratio (OR) of 9.17 (p = 0.002; 95% confidence interval (CI): 0.026 to 0.455) adjusted risk of neurologic deterioration compared with those without obliteration of basal cistern. An increase of 1 point in the ICH score on admission would increase the neurologic deterioration rate by 83.2% (p = 0.010; 95% CI: 1.153 to 2.912). The ROC curves showed that the AUC for ICH score on presentation was 0.719 (p = 0.000; 95% CI: 0.613–0.826) and the cutoff value was 2.5 (sensitivity 80.5% and specificity 73.7%). Conclusion Patients had obliteration of basal cistern on initial brain CT and ICH score greater or equal to 3 at admission implies a greater danger of neurologic deterioration during hospitalization. Cautious clinical assessments and repeated brain images study are mandatory for those high-risk patients to prevent neurologic deterioration during hospitalization.
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Affiliation(s)
- Yu-Ni Ho
- Departments of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shih-Yuan Hsu
- Departments of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Ta Pei Road, Niao Sung, Kaohsiung, Taiwan
| | - Yu-Tsai Lin
- Departments of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Fu-Chang Cheng
- Departments of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Jun Lin
- Departments of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Ta Pei Road, Niao Sung, Kaohsiung, Taiwan.,Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Nai-Wen Tsai
- Departments of Neurology Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Hsien Lu
- Departments of Neurology Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Hung-Chen Wang
- Departments of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123, Ta Pei Road, Niao Sung, Kaohsiung, Taiwan.
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13
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Di Russo P, Di Carlo DT, Lutenberg A, Morganti R, Evins AI, Perrini P. Shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage. J Neurosurg Sci 2019; 64:181-189. [PMID: 30942051 DOI: 10.23736/s0390-5616.19.04641-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Shunt-dependent hydrocephalus (SDHC) after aneurysmal subarachnoid hemorrhage (aSAH) is the occurrence of symptomatic ventriculomegaly requiring permanent shunt diversion. Although several studies investigated the predictors of SDHC, the role of many of these factors, as well as the prevalence of SDHC and patients' clinical outcome, remain a matter of controversy. EVIDENCE ACQUISITION According to PRISMA guidelines we performed a systematic search looking into four databases with the purpose of clarifying the prevalence of SDHC after aSAH, the predictors of SDHC, the mortality rate and clinical outcome of patients with and without SDHC. EVIDENCE SYNTHESIS Our analysis included 23 studies involving 22,264 patients. The overall prevalence of SDHC was 22.3% (95% CI: 17.9-26.6%). The predictors of SDHC included radiological hydrocephalus at presentation (OR 6.3, 95% CI: 2.27-17.51%), external ventricular drainage insertion (OR 5.7, 95% CI: 3.77-8.61%), high Hunt and Hess scale score (HHS 3-5: OR 3.3, 95% CI: 2.64-4.15%; HHS 4-5: OR 3.2, 95% CI: 2.4-4.2%), high Fisher grade (OR 3.1, 95% CI: 2.58-3.72%), intraventricular blood (OR 3.1, 95% CI: 2.60-3.71%), vasospasm (OR 1.9, 95% CI: 1.30-2.81%), intraparenchymal hemorrhage (OR 1.8, 95% CI: 1.2-2.78%), female gender (OR 1.3, 95% CI: 1.14-1.65%) and posterior circulation aneurysms (OR 1.4, 95% CI: 1.11-1.71%). The modality of aneurysm repair did not affect the rate of permanent shunt diversion. Patients with SDHC were more likely to be associated with a poor clinical outcome (mRS 3-6) (OR 4.3), even if mortality rate was similar between shunted and non-shunted patients (9%, 95% CI: 2-16% vs. 10.8%, 95% CI: 3.2-18.5%) (P=0.09). CONCLUSIONS The prevalence of SDHC is 22.3%. Our analysis identified several predictors of SDHC that can assist clinicians in monitoring patients with an aSAH. Shunt dependency is not related to the treatment modality of the ruptured aneurysm, whereas the occurrence of SDHC is a predictor of poor clinical outcome.
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Affiliation(s)
- Paolo Di Russo
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, Italy
| | - Davide T Di Carlo
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, Italy
| | - Ariel Lutenberg
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, Italy
| | - Riccardo Morganti
- Section of Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alexander I Evins
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Paolo Perrini
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, Italy -
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14
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Lenski M, Biczok A, Huge V, Forbrig R, Briegel J, Tonn JC, Thon N. Role of Cerebrospinal Fluid Markers for Predicting Shunt-Dependent Hydrocephalus in Patients with Subarachnoid Hemorrhage and External Ventricular Drain Placement. World Neurosurg 2018; 121:e535-e542. [PMID: 30268545 DOI: 10.1016/j.wneu.2018.09.159] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We sought to identify potential risk factors for the development of shunt-dependent chronic hydrocephalus after aneurysmal subarachnoid hemorrhage (SAH) and external ventricular drain (EVD) insertion. In particular, the role of inflammatory markers within the cerebrospinal fluid (CSF) was assessed. METHODS For this single-center analysis, data were generated from consecutive patients with SAH and the need for EVD implantation treated on our neurosurgical intensive care unit between 2013 and 2015. Parameters were patient characteristics (age, sex, comorbidity), severity of SAH (according to the World Federation of Neurological Society score), imaging findings (intraventricular hemorrhage, diameter of the third ventricle, location of the ruptured aneurysm), and acute course of disease (cerebral infarction, vasospasm). Moreover, the impact of EVD drainage volume and CSF markers (total protein [CSFTP], red blood cell count [CSFRBC], interleukin-6 [CSFIL-6], and glucose [CSFGlc]) was assessed. Statistics including receiver-operating-curve with corresponding area-under-the-curve (AUC) analysis were calculated using SPSS. RESULTS Overall, 63 patients (21 males, mean age 55.2 years) were included. Twenty-one patients (30%) developed a shunt-dependent hydrocephalus. Significant risk factors for shunt dependency were the World Federation of Neurological Society score, cerebral infarction, and diameter of the third ventricle (P < 0.05). Moreover, CSF markers associated with shunt-dependent hydrocephalus included increased levels of CSFTP on days 5 (AUC = 0.72)/11 (AUC = 0.97)/14 (AUC = 0.98), CSFIL-6 on day 14 (AUC = 0.81), and CSFRBC on day 15 (AUC = 0.83). The EVD drainage volume was not prognostic. CONCLUSIONS The time course of selected inflammatory markers in CSF may support management considerations in the early phase after SAH and critical impairment of CSF circulation.
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Affiliation(s)
- Markus Lenski
- Neurochirurgische Klinik und Poliklinik, Klinikum Großhadern, Ludwig Maximilian Universität, Munich, Germany.
| | - Annamaria Biczok
- Neurochirurgische Klinik und Poliklinik, Klinikum Großhadern, Ludwig Maximilian Universität, Munich, Germany
| | - Volker Huge
- Klinik für Anästhesiologie, Klinikum Großhadern, Ludwig Maximilian Universität, Munich, Germany
| | - Robert Forbrig
- Klinik für Neuroradiologie, Klinikum Großhadern, Ludwig Maximilian Universität, Munich, Germany
| | - Josef Briegel
- Klinik für Anästhesiologie, Klinikum Großhadern, Ludwig Maximilian Universität, Munich, Germany
| | - Jörg-Christian Tonn
- Neurochirurgische Klinik und Poliklinik, Klinikum Großhadern, Ludwig Maximilian Universität, Munich, Germany
| | - Niklas Thon
- Neurochirurgische Klinik und Poliklinik, Klinikum Großhadern, Ludwig Maximilian Universität, Munich, Germany
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15
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Santucci JA, Ross SR, Greenert JC, Aghaei F, Ford L, Hollabaugh KM, Cornwell BO, Wu DH, Zheng B, Bohnstedt BN, Ray B. Radiological Estimation of Intracranial Blood Volume and Occurrence of Hydrocephalus Determines Stress-Induced Hyperglycemia After Aneurysmal Subarachnoid Hemorrhage. Transl Stroke Res 2018; 10:10.1007/s12975-018-0646-7. [PMID: 29992443 DOI: 10.1007/s12975-018-0646-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/22/2018] [Accepted: 07/02/2018] [Indexed: 12/17/2022]
Abstract
Acute phase after aneurysmal subarachnoid hemorrhage (aSAH) is associated with several metabolic derangements including stress-induced hyperglycemia (SIH). The present study is designed to identify objective radiological determinants for SIH to better understand its contributory role in clinical outcomes after aSAH. A computer-aided detection tool was used to segment admission computed tomography (CT) images of aSAH patients to estimate intracranial blood and cerebrospinal fluid volumes. Modified Graeb score (mGS) was used as a semi-quantitative measure to estimate degree of hydrocephalus. The relationship between glycemic gap (GG) determined SIH, mGS, and estimated intracranial blood and cerebrospinal fluid volumes were evaluated using linear regression. Ninety-four [94/187 (50.3%)] among the study cohort had SIH (defined as GG > 26.7 mg/dl). Patients with SIH had 14.3 ml/1000 ml more intracranial blood volume as compared to those without SIH [39.6 ml (95% confidence interval, CI, 33.6 to 45.5) vs. 25.3 ml (95% CI 20.6 to 29.9), p = 0.0002]. Linear regression analysis of mGS with GG showed each unit increase in mGS resulted in 1.2 mg/dl increase in GG [p = 0.002]. Patients with SIH had higher mGS [median 4.0, interquartile range, IQR 2.0-7.0] as compared to those without SIH [median 2.0, IQR 0.0-6.0], p = 0.002. Patients with third ventricular blood on admission CT scan were more likely to develop SIH [67/118 (56.8%) vs. 27/69 (39.1%), p = 0.023]. Hence, the present study, using unbiased SIH definition and objective CT scan parameters, reports "dose-dependent" radiological features resulting in SIH. Such findings allude to a brain injury-stress response-neuroendocrine axis in etiopathogenesis of SIH.
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Affiliation(s)
- Joshua A Santucci
- Division of Critical Care Neurology, Department of Neurology, College of Medicine, The University of Oklahoma Health Sciences Center, 920 Stanton L Young Blvd; Ste 2040, Oklahoma City, OK, 73104, USA
| | - Stephen R Ross
- Division of Critical Care Neurology, Department of Neurology, College of Medicine, The University of Oklahoma Health Sciences Center, 920 Stanton L Young Blvd; Ste 2040, Oklahoma City, OK, 73104, USA
| | - John C Greenert
- Division of Critical Care Neurology, Department of Neurology, College of Medicine, The University of Oklahoma Health Sciences Center, 920 Stanton L Young Blvd; Ste 2040, Oklahoma City, OK, 73104, USA
| | - Faranak Aghaei
- Electrical Engineering, University of Oklahoma, Norman, OK, USA
| | - Lance Ford
- Epidemiology and Biostatistics, College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kimberly M Hollabaugh
- Epidemiology and Biostatistics, College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Benjamin O Cornwell
- Radiology, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Dee H Wu
- Radiology, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Bin Zheng
- Electrical Engineering, University of Oklahoma, Norman, OK, USA
| | - Bradley N Bohnstedt
- Neurosurgery, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Bappaditya Ray
- Division of Critical Care Neurology, Department of Neurology, College of Medicine, The University of Oklahoma Health Sciences Center, 920 Stanton L Young Blvd; Ste 2040, Oklahoma City, OK, 73104, USA.
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16
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Predicting factors for shunt-dependent hydrocephalus in patients with aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 2018; 160:1407-1413. [PMID: 29766339 DOI: 10.1007/s00701-018-3560-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 05/03/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Chronic hydrocephalus after aneurysmal subarachnoid hemorrhage (SAH) is a major complication that leads to a medical burden and poor clinical outcomes. The aim of this study was to evaluate the predictive factors of shunt-dependent hydrocephalus focusing on postoperative fever and infection. METHOD A total of 418 patients were included in this study and the patient demographic features, radiologic findings, days of fever burden, and infection were compared between the shunt (n = 72) and no shunt group (n = 346). Days of fever burden was defined as the total number of days with the highest body temperature ≥ 38.0 °C each day from day 1 to day 14. Pneumonia, urinary tract infection (UTI), meningitis, and bacteremia were recorded in all patients. RESULTS The independent predictive factors for shunt-dependent hydrocephalus were older age ≥ 65, microsurgical clipping, placement of extraventricular drainage (EVD), days of fever burden, and infection. The incidence of shunt dependency was 2.4% in the no fever burden patients (n = 123), 14.9% in the 1-3 days of fever burden patients (n = 161), 27.0% in the 4-6 days of fever burden patients (n = 74), and 41.7% in the ≥ 7 days of fever burden patients with statistical significance among groups (p < 0.001). CONCLUSION The rate of shunt dependency increased proportionally as the days of fever burden increased. Older age (≥ 65), microsurgical clipping, placement of EVD, days of fever burden, and infection were independent predictive factors for shunt dependency. Proper postoperative care for maintaining normal body temperature and preventing infectious disease can help reduce the rate of shunt dependency and improve clinical outcomes.
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17
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Wessell AP, Kole MJ, Cannarsa G, Oliver J, Jindal G, Miller T, Gandhi D, Parikh G, Badjatia N, Aldrich EF, Simard JM. A sustained systemic inflammatory response syndrome is associated with shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage. J Neurosurg 2018; 130:1984-1991. [PMID: 29957109 DOI: 10.3171/2018.1.jns172925] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 01/26/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors sought to evaluate whether a sustained systemic inflammatory response was associated with shunt-dependent hydrocephalus following aneurysmal subarachnoid hemorrhage. METHODS A retrospective analysis of 193 consecutive patients with aneurysmal subarachnoid hemorrhage was performed. Management of hydrocephalus followed a stepwise algorithm to determine the need for external CSF drainage and subsequent shunt placement. Systemic inflammatory response syndrome (SIRS) data were collected for all patients during the first 7 days of hospitalization. Patients who met the SIRS criteria every day for the first 7 days of hospitalization were considered as having a sustained SIRS. Univariate and multivariate regression analyses were used to determine predictors of shunt dependence. RESULTS Sixteen percent of patients required shunt placement. Sustained SIRS was observed in 35% of shunt-dependent patients compared to 14% in non-shunt-dependent patients (p = 0.004). On multivariate logistic regression, female sex (OR 0.35, 95% CI 0.142-0.885), moderate to severe vasospasm (OR 3.78, 95% CI 1.333-10.745), acute hydrocephalus (OR 21.39, 95% CI 2.260-202.417), and sustained SIRS (OR 2.94, 95% CI 1.125-7.689) were significantly associated with shunt dependence after aneurysmal subarachnoid hemorrhage. Receiver operating characteristic analysis revealed an area under the curve of 0.83 for the final regression model. CONCLUSIONS Sustained SIRS was a predictor of shunt-dependent hydrocephalus following aneurysmal subarachnoid hemorrhage even after adjustment for potential confounding variables in a multivariate logistic regression model.
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Affiliation(s)
| | | | | | | | - Gaurav Jindal
- Departments of1Neurosurgery
- 4Neurology
- 6Radiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Timothy Miller
- 6Radiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Dheeraj Gandhi
- Departments of1Neurosurgery
- 4Neurology
- 6Radiology, University of Maryland School of Medicine, Baltimore, Maryland
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18
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Fernandez-Maza L, Egea-Guerrero JJ, Balcerzyk M, Civantos-Jubera G, Gordillo-Escobar E, Vilches-Arenas A, Fernandez-Gomez I, Parrado-Gallego A, Murillo-Cabezas F. Rapid and simplified synthesis of [ 18 F]Fluoromisonidazole and its use in PET imaging in an experimental model of subarachnoid hemorrhage. Appl Radiat Isot 2018; 132:79-84. [DOI: 10.1016/j.apradiso.2017.09.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 08/28/2017] [Accepted: 09/22/2017] [Indexed: 01/08/2023]
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19
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Gupta R, Ascanio LC, Enriquez-Marulanda A, Griessenauer CJ, Chinnadurai A, Jhun R, Alturki A, Ogilvy CS, Thomas AJ, Moore JM. Validation of a Predictive Scoring System for Ventriculoperitoneal Shunt Insertion After Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2018; 109:e210-e216. [DOI: 10.1016/j.wneu.2017.09.140] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
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20
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Xie Z, Hu X, Zan X, Lin S, Li H, You C. Predictors of Shunt-dependent Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage? A Systematic Review and Meta-Analysis. World Neurosurg 2017; 106:844-860.e6. [PMID: 28652120 DOI: 10.1016/j.wneu.2017.06.119] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 06/17/2017] [Accepted: 06/19/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hydrocephalus is a well-recognized complication after aneurysmal subarachnoid hemorrhage (aSAH). This study aimed to identify predictors for shunt-dependent hydrocephalus (SDHC) after aSAH via a systematic review and meta-analysis. METHODS A systematic search was conducted using the Embase, MEDLINE, and Web of Science databases for studies pertaining to aSAH and SDHC. Risk factors were assessed by meta-analysis when they were reported by at least 2 studies. The results were presented as odd ratios or risk ratios according to the study design with the corresponding 95% confidence intervals (CI). RESULTS Twenty-five studies were included. In primary analysis of 14 potential risk factors, 12 were identified as predictors of SDHC after aSAH including age ≥50 years, female gender, high Hunt-Hess grade, Glasgow Coma Scale ≤8, Fisher grade ≥3, acute hydrocephalus, external ventricular drainage insertion, intraventricular hemorrhage, postcirculation aneurysm, anterior communicating artery aneurysm, meningitis, and rebleeding. The meta-analysis based on cohort studies found a significantly increased risk for SDHC in patients with aSAH treated by coiling (risk ratio, 1.16; 95% CI, 1.05-1.29), while the meta-analysis based on case-controlled studies failed to replicate this finding (odds ratio, 1.27; 95% CI, 0.95-1.71). CONCLUSIONS Several new predictors of SDHC after aSAH were identified that may assist with the early recognition and prevention of SDHC. The controversial evidence found in this study was insufficient to support the potential of neurosurgical clipping for reducing the risk of shunt dependency. Further well-designed studies are warranted to explore the effect of treatment modality on SDHC risk.
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Affiliation(s)
- Zhiyi Xie
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xin Hu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xin Zan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Sen Lin
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hao Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chao You
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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21
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Hsu SY, Chang HH, Shih FY, Lin YJ, Lin WC, Cheng BC, Su YJ, Kung CT, Ho YN, Tsai NW, Lu CH, Wang HC. Risk Factors for Ventriculoperitoneal Shunt Dependency in Patients with Spontaneous Cerebellar Hemorrhage. World Neurosurg 2017; 105:63-68. [PMID: 28559078 DOI: 10.1016/j.wneu.2017.05.119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 05/18/2017] [Accepted: 05/19/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hydrocephalus is a common complication after spontaneous cerebellar hemorrhage (CH). This study focused on predicting ventriculoperitorneal (VP) shunt dependency in patients with spontaneous CH. METHODS Ninety-nine patients with spontaneous CH were evaluated in this retrospective study. A comparison between patients with and those without VP shunt dependency during hospitalization was made. RESULTS VP shunt-dependent hydrocephalus developed in 19.2% of the patients (19 of 99). Comparison of neuroimaging findings on admission between the 2 patient groups identified large hematoma dimension (P < 0.001), large hematoma volume (P = 0.001), fourth ventricular degradation (P < 0.001), development of hydrocephalus (P < 0.001), and obliteration of the basal cisterns (P < 0.001) as significant risk factors for VP shunt-dependent hydrocephalus. Stepwise logistic regression analysis identified hydrocephalus on admission and maximum hematoma diameter on admission as independent risk factors for VP shunt dependency (P = 0.006 and 0.020, respectively). The adjusted risk of VP shunt dependency for patients with hydrocephalus on admission had an odds ratio of 37.04. Furthermore, an increase of 1 mm in the blood clot diameter on admission would increase the VP shunt dependency rate by 11.9%. The cutoff value of blood clot diameter on presentation was 36.15 mm (sensitivity, 84.2%; specificity, 85.0%). CONCLUSIONS A patient with hydrocephalus on admission and a hematoma of larger size and dimension at the time of initial imaging is at elevated risk for VP shunt dependency. Repeat neuroimaging studies and careful clinical assessment are mandatory for high-risk patients to determine the presence of post-CH hydrocephalus.
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Affiliation(s)
- Shih-Yuan Hsu
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsin-Huan Chang
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Fu-Yuan Shih
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Jun Lin
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ben-Chung Cheng
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Jih Su
- Department of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Te Kung
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Ni Ho
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Nai-Wen Tsai
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Hsien Lu
- Department of Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hung-Chen Wang
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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22
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Hua C, Zhao G. Adult posthaemorrhagic hydrocephalus animal models. J Neurol Sci 2017; 379:39-43. [PMID: 28716276 DOI: 10.1016/j.jns.2017.05.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 05/18/2017] [Accepted: 05/19/2017] [Indexed: 12/26/2022]
Abstract
Posthaemorrhagic hydrocephalus (PHH) is often associated with high morbidity and mortality and serves as an important clinical predictor of poor outcomes after intracranial haemorrhage (ICH). We are lack of effective medical intervention methods to improve functional outcomes in patients with PHH because little is still known about the mechanisms of PHH pathogenesis. Animal models play a key role in the study of PHH. Developed a suitable animal model that will help us to be better to find preventative strategies and improve the prognosis of patients with PHH. The purpose of this review is to summarize the body of knowledge gained from animal studies.
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Affiliation(s)
- Cong Hua
- Department of Neurosurgery of the First Clinical Hospital, Jilin University, Changchun, China.
| | - Gang Zhao
- Department of Neurosurgery of the First Clinical Hospital, Jilin University, Changchun, China.
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Ray B, Ludwig A, Yearout LK, Thompson DM, Bohnstedt BN. Stress-Induced Hyperglycemia After Spontaneous Subarachnoid Hemorrhage and Its Role in Predicting Cerebrospinal Fluid Diversion. World Neurosurg 2017; 100:208-215. [DOI: 10.1016/j.wneu.2017.01.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/01/2017] [Accepted: 01/03/2017] [Indexed: 01/04/2023]
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Chen Q, Feng Z, Tan Q, Guo J, Tang J, Tan L, Feng H, Chen Z. Post-hemorrhagic hydrocephalus: Recent advances and new therapeutic insights. J Neurol Sci 2017; 375:220-230. [PMID: 28320134 DOI: 10.1016/j.jns.2017.01.072] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 01/25/2017] [Accepted: 01/30/2017] [Indexed: 02/07/2023]
Abstract
Post-hemorrhagic hydrocephalus (PHH), also referred to as progressive ventricular dilatation, is caused by disturbances in cerebrospinal fluid (CSF) flow or absorption following hemorrhage in the brain. As one of the most serious complications of neonatal/adult intraventricular hemorrhage (IVH), subarachnoid hemorrhage (SAH), and traumatic brain injury (TBI), PHH is associated with increased morbidity and disability of these events. Common sequelae of PHH include neurocognitive impairment, motor dysfunction, and growth impairment. Non-surgical measures to reduce increased intracranial pressure (ICP) in PHH have shown little success and most patients will ultimately require surgical management, such as external ventricular drainage and shunting which mostly by inserting a CSF drainage shunt. Unfortunately, shunt complications are common and the optimum time for intervention is unclear. To date, there remains no comprehensive strategy for PHH management and it becomes imperative that to explore new therapeutic targets and methods for PHH. Over past decades, increasing evidence have indicated that hemorrhage-derived blood and subsequent metabolic products may play a key role in the development of IVH-, SAH- and TBI-associated PHH. Several intervention strategies have recently been evaluated and cross-referenced. In this review, we summarized and discussed the common aspects of hydrocephalus following IVH, SAH and TBI, relevant experimental animal models, clinical translation of in vivo experiments, and potential preventive and therapeutic targets for PHH.
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Affiliation(s)
- Qianwei Chen
- Department of Neurosurgery, Southwest Hospital, The Third Military Medical University, Chongqing 400038, China
| | - Zhou Feng
- Department of Neurosurgery, Southwest Hospital, The Third Military Medical University, Chongqing 400038, China
| | - Qiang Tan
- Department of Neurosurgery, Southwest Hospital, The Third Military Medical University, Chongqing 400038, China
| | - Jing Guo
- Department of Neurosurgery, Southwest Hospital, The Third Military Medical University, Chongqing 400038, China; Department of Neurosurgery, The 211st Hospital of PLA, Harbin 150086, China
| | - Jun Tang
- Department of Neurosurgery, Southwest Hospital, The Third Military Medical University, Chongqing 400038, China
| | - Liang Tan
- Department of Neurosurgery, Southwest Hospital, The Third Military Medical University, Chongqing 400038, China
| | - Hua Feng
- Department of Neurosurgery, Southwest Hospital, The Third Military Medical University, Chongqing 400038, China.
| | - Zhi Chen
- Department of Neurosurgery, Southwest Hospital, The Third Military Medical University, Chongqing 400038, China.
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Tao C, Fan C, Hu X, Ma J, Ma L, Li H, Liu Y, Sun H, He M, You C. The effect of fenestration of the lamina terminalis on the incidence of shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage (FISH): Study protocol for a randomized controlled trial. Medicine (Baltimore) 2016; 95:e5727. [PMID: 28033279 PMCID: PMC5207575 DOI: 10.1097/md.0000000000005727] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Shunt-dependent hydrocephalus (SDH) is a well-known sequela following aneurysmal hemorrhage, adversely affecting the outcome after securing ruptured aneurysm. Fenestration of lamina terminalis (FLT) creates an anterior ventriculostomy, facilitates cerebrospinal fluid circulation and clot clearance in the basal cistern. However, controversy exists over whether microsurgical FLT during aneurysm repair can decrease the incidence of SDH. AIMS The study is designed to determine the efficacy of lamina terminalis fenestration on the reduction of SDH after aneurysm clipping. METHODS/DESIGN A total of 288 patients who meet the inclusion criteria will be randomized into single aneurysm clipping or aneurysm clipping plus FLT in the Department of Neurosurgery, West China Hospital. Follow-up was performed 1, 3, 6, and 12 months after aneurysm clipping. The primary outcome is the incidence of SDH and the secondary outcomes include cerebral vasospasm, functional outcome evaluated by the modified Rankin Scale and Extended Glasgow Outcome Scale, and mortality. DISCUSSION The FISH trial is a large randomized, parallel controlled clinical trial to define the therapeutic value of FLT, the results of which will help to guide the surgical procedure and resolve the long-puzzled debate in the neurosurgical community. CONCLUSIONS This protocol will determine the efficacy of FLT in the setting of aneurysmal subarachnoid hemorrhage. TRIAL REGISTRATION IDENTIFIER CHINESE CLINICAL TRIAL REGISTRY:: ChiCTR-INR-16009249.
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Adams H, Ban VS, Leinonen V, Aoun SG, Huttunen J, Saavalainen T, Lindgren A, Frosen J, Fraunberg M, Koivisto T, Hernesniemi J, Welch BG, Jaaskelainen JE, Huttunen TJ. Risk of Shunting After Aneurysmal Subarachnoid Hemorrhage. Stroke 2016; 47:2488-96. [DOI: 10.1161/strokeaha.116.013739] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 08/05/2016] [Indexed: 01/30/2023]
Abstract
Background and Purpose—
Shunt dependent hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH) is a common sequela that may lead to poor neurological outcome and predisposes to various interventions, admissions, and complications. We reviewed post-aSAH shunt dependency in a population-based sample and tested the feasibility of a clinical risk score to identify subgroups of aSAH patients with increasing risk of shunting for hydrocephalus.
Methods—
A total of 1533 aSAH patients from the population-based Eastern Finland Saccular Intracranial Aneurysm Database (Kuopio, Finland) were used in a recursive partitioning analysis to identify risk factors for shunting after aSAH. The risk model was built and internally validated in random split cohorts. External validation was conducted on 946 aSAH patients from the Southwestern Tertiary Aneurysm Registry (Dallas, TX) and tested using receiver-operating characteristic curves.
Results—
Of all patients alive ≥14 days, 17.7% required permanent cerebrospinal fluid diversion. The recursive partitioning analysis defined 6 groups with successively increased risk for shunting. These groups also successively risk stratified functional outcome at 12 months, shunt complications, and time-to-shunt rates. The area under the curve–receiver-operating characteristic curve for the exploratory sample and internal validation sample was 0.82 and 0.78, respectively, with an external validation of 0.68.
Conclusions—
Shunt dependency after aSAH is associated with higher morbidity and mortality, and prediction modeling of shunt dependency is feasible with clinically useful yields. It is important to identify and understand the factors that increase risk for shunting and to eliminate or mitigate the reversible factors. The aSAH-PARAS Consortium (Aneurysmal Subarachnoid Hemorrhage Patients’ Risk Assessment for Shunting) has been initiated to pool the collective insights and resources to address key questions in post-aSAH shunt dependency to inform future aSAH treatment guidelines.
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Affiliation(s)
- Hadie Adams
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Finland (H.A., V.L., J. Huttunen, T.S., A.L., J.F., M.F., T.K., J.E.J., T.J.H.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (V.S.B., S.G.A., B.G.W.); and Department of Neurosurgery, Helsinki University Hospital, Finland (J. Hernesniemi)
| | - Vin Shen Ban
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Finland (H.A., V.L., J. Huttunen, T.S., A.L., J.F., M.F., T.K., J.E.J., T.J.H.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (V.S.B., S.G.A., B.G.W.); and Department of Neurosurgery, Helsinki University Hospital, Finland (J. Hernesniemi)
| | - Ville Leinonen
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Finland (H.A., V.L., J. Huttunen, T.S., A.L., J.F., M.F., T.K., J.E.J., T.J.H.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (V.S.B., S.G.A., B.G.W.); and Department of Neurosurgery, Helsinki University Hospital, Finland (J. Hernesniemi)
| | - Salah G. Aoun
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Finland (H.A., V.L., J. Huttunen, T.S., A.L., J.F., M.F., T.K., J.E.J., T.J.H.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (V.S.B., S.G.A., B.G.W.); and Department of Neurosurgery, Helsinki University Hospital, Finland (J. Hernesniemi)
| | - Jukka Huttunen
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Finland (H.A., V.L., J. Huttunen, T.S., A.L., J.F., M.F., T.K., J.E.J., T.J.H.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (V.S.B., S.G.A., B.G.W.); and Department of Neurosurgery, Helsinki University Hospital, Finland (J. Hernesniemi)
| | - Taavi Saavalainen
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Finland (H.A., V.L., J. Huttunen, T.S., A.L., J.F., M.F., T.K., J.E.J., T.J.H.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (V.S.B., S.G.A., B.G.W.); and Department of Neurosurgery, Helsinki University Hospital, Finland (J. Hernesniemi)
| | - Antti Lindgren
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Finland (H.A., V.L., J. Huttunen, T.S., A.L., J.F., M.F., T.K., J.E.J., T.J.H.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (V.S.B., S.G.A., B.G.W.); and Department of Neurosurgery, Helsinki University Hospital, Finland (J. Hernesniemi)
| | - Juhana Frosen
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Finland (H.A., V.L., J. Huttunen, T.S., A.L., J.F., M.F., T.K., J.E.J., T.J.H.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (V.S.B., S.G.A., B.G.W.); and Department of Neurosurgery, Helsinki University Hospital, Finland (J. Hernesniemi)
| | - Mikael Fraunberg
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Finland (H.A., V.L., J. Huttunen, T.S., A.L., J.F., M.F., T.K., J.E.J., T.J.H.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (V.S.B., S.G.A., B.G.W.); and Department of Neurosurgery, Helsinki University Hospital, Finland (J. Hernesniemi)
| | - Timo Koivisto
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Finland (H.A., V.L., J. Huttunen, T.S., A.L., J.F., M.F., T.K., J.E.J., T.J.H.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (V.S.B., S.G.A., B.G.W.); and Department of Neurosurgery, Helsinki University Hospital, Finland (J. Hernesniemi)
| | - Juha Hernesniemi
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Finland (H.A., V.L., J. Huttunen, T.S., A.L., J.F., M.F., T.K., J.E.J., T.J.H.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (V.S.B., S.G.A., B.G.W.); and Department of Neurosurgery, Helsinki University Hospital, Finland (J. Hernesniemi)
| | - Babu G. Welch
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Finland (H.A., V.L., J. Huttunen, T.S., A.L., J.F., M.F., T.K., J.E.J., T.J.H.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (V.S.B., S.G.A., B.G.W.); and Department of Neurosurgery, Helsinki University Hospital, Finland (J. Hernesniemi)
| | - Juha E. Jaaskelainen
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Finland (H.A., V.L., J. Huttunen, T.S., A.L., J.F., M.F., T.K., J.E.J., T.J.H.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (V.S.B., S.G.A., B.G.W.); and Department of Neurosurgery, Helsinki University Hospital, Finland (J. Hernesniemi)
| | - Terhi J. Huttunen
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Finland (H.A., V.L., J. Huttunen, T.S., A.L., J.F., M.F., T.K., J.E.J., T.J.H.); Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (V.S.B., S.G.A., B.G.W.); and Department of Neurosurgery, Helsinki University Hospital, Finland (J. Hernesniemi)
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Jabbarli R, Müller O. Authors' reply. Eur J Neurol 2016; 23:e42-3. [DOI: 10.1111/ene.13035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 04/04/2016] [Indexed: 11/30/2022]
Affiliation(s)
- R. Jabbarli
- Department of Neurosurgery; University Hospital Essen; Essen Germany
| | - O. Müller
- Department of Neurosurgery; University Hospital Essen; Essen Germany
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Wilson CD, Safavi-Abbasi S, Sun H, Kalani MYS, Zhao YD, Levitt MR, Hanel RA, Sauvageau E, Mapstone TB, Albuquerque FC, McDougall CG, Nakaji P, Spetzler RF. Meta-analysis and systematic review of risk factors for shunt dependency after aneurysmal subarachnoid hemorrhage. J Neurosurg 2016; 126:586-595. [PMID: 27035169 DOI: 10.3171/2015.11.jns152094] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Aneurysmal subarachnoid hemorrhage (aSAH) may be complicated by hydrocephalus in 6.5%-67% of cases. Some patients with aSAH develop shunt dependency, which is often managed by ventriculoperitoneal shunt placement. The objectives of this study were to review published risk factors for shunt dependency in patients with aSAH, determine the level of evidence for each factor, and calculate the magnitude of each risk factor to better guide patient management. METHODS The authors searched PubMed and MEDLINE databases for Level A and Level B articles published through December 31, 2014, that describe factors affecting shunt dependency after aSAH and performed a systematic review and meta-analysis, stratifying the existing data according to level of evidence. RESULTS On the basis of the results of the meta-analysis, risk factors for shunt dependency included high Fisher grade (OR 7.74, 95% CI 4.47-13.41), acute hydrocephalus (OR 5.67, 95% CI 3.96-8.12), in-hospital complications (OR 4.91, 95% CI 2.79-8.64), presence of intraventricular blood (OR 3.93, 95% CI 2.80-5.52), high Hunt and Hess Scale score (OR 3.25, 95% CI 2.51-4.21), rehemorrhage (OR 2.21, 95% CI 1.24-3.95), posterior circulation location of the aneurysm (OR 1.85, 95% CI 1.35-2.53), and age ≥ 60 years (OR 1.81, 95% CI 1.50-2.19). The only risk factor included in the meta-analysis that did not reach statistical significance was female sex (OR 1.13, 95% CI 0.77-1.65). CONCLUSIONS The authors identified several risk factors for shunt dependency in aSAH patients that help predict which patients are likely to require a permanent shunt. Although some of these risk factors are not independent of each other, this information assists clinicians in identifying at-risk patients and managing their treatment.
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Affiliation(s)
| | - Sam Safavi-Abbasi
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Hai Sun
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - M Yashar S Kalani
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Yan D Zhao
- Biostatistics and Epidemiology, University of Oklahoma, Oklahoma City, Oklahoma
| | - Michael R Levitt
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Ricardo A Hanel
- Lyerly Neurosurgery, Baptist Hospital, Jacksonville, Florida
| | - Eric Sauvageau
- Lyerly Neurosurgery, Baptist Hospital, Jacksonville, Florida
| | | | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Cameron G McDougall
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Peter Nakaji
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Robert F Spetzler
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
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Jabbarli R, Bohrer AM, Pierscianek D, Müller D, Wrede KH, Dammann P, El Hindy N, Özkan N, Sure U, Müller O. The CHESS score: a simple tool for early prediction of shunt dependency after aneurysmal subarachnoid hemorrhage. Eur J Neurol 2016; 23:912-8. [PMID: 26918845 DOI: 10.1111/ene.12962] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 12/22/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Acute hydrocephalus is an early and common complication of aneurysmal subarachnoid hemorrhage (SAH). However, considerably fewer patients develop chronic hydrocephalus requiring shunt placement. Our aim was to develop a risk score for early identification of patients with shunt dependency after SAH. METHODS Two hundred and forty-two SAH individuals who were treated in our institution between January 2008 and December 2013 and survived the initial impact were retrospectively analyzed. Clinical parameters within 72 h after the ictus were correlated with shunt dependency. Independent predictors were summarized into a new risk score which was validated in a subsequent SAH cohort treated between January and December 2014. RESULTS Seventy-five patients (31%) underwent shunt placement. Of 23 evaluated variables, only the following five showed independent associations with shunt dependency and were subsequently used to establish the Chronic Hydrocephalus Ensuing from SAH Score (CHESS, 0-8 points): Hunt and Hess grade ≥IV (1 point), location of the ruptured aneurysm in the posterior circulation (1 point), acute hydrocephalus (4 points), the presence of intraventricular hemorrhage (1 point) and early cerebral infarction on follow-up computed tomography scan (1 point). The CHESS showed strong correlation with shunt dependency (P = 0.0007) and could be successfully validated in both internal SAH cohorts tested. Patients scoring ≥6 CHESS points had significantly higher risk of shunt dependency (P < 0.0001) than other patients. CONCLUSION The CHESS may become a valuable diagnostic tool for early estimation of shunt dependency after SAH. Further evaluation and external validation will be required in prospective studies.
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Affiliation(s)
- R Jabbarli
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - A-M Bohrer
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - D Pierscianek
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - D Müller
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - K H Wrede
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - P Dammann
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - N El Hindy
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - N Özkan
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - U Sure
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - O Müller
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
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Tso MK, Ibrahim GM, Macdonald RL. Predictors of Shunt-Dependent Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2015; 86:226-32. [PMID: 26428322 DOI: 10.1016/j.wneu.2015.09.056] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/16/2015] [Accepted: 09/16/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Shunt-dependent hydrocephalus is a common complication of aneurysmal subarachnoid hemorrhage (aSAH). There is a need to identify patients who require ventriculoperitoneal shunt (VPS) insertion so that any modifiable risk factors can be addressed early after aSAH. METHODS Exploratory analysis was performed on 413 patients enrolled in CONSCIOUS-1, a prospective randomized controlled trial of patients with aSAH treated with clazosentan. The association between clinical and neuroimaging covariates and VPS placement was first determined by univariate analysis. Covariates with P < 0.15 on univariate analysis were then analyzed in a multivariate logistic regression model. Receiver operating characteristic curve analysis was used to define optimal predictive thresholds. The published literature was reviewed to determine the overall rate of VPS insertion after aSAH. RESULTS Overall, 17.2% (71/413) of patients required VPS insertion. Multivariate analysis demonstrated that insertion of an external ventricular drain (odds ratio, 6.21; 95% confidence interval, 2.51-16.91) and increasing volume of cerebrospinal fluid (CSF) drainage per day (odds ratio, 1.004; 95% confidence interval, 1.000-1.009) were associated with VPS insertion. Receiver operating characteristic curve analysis revealed an optimal daily CSF output threshold of 78 mL was predictive of VPS insertion. Among 41,789 patients with aSAH from 66 published studies, the overall VPS insertion rate was 12.7%. CONCLUSIONS The presence of an external ventricular drain and increased daily CSF output (above 78 mL/day) seems to be predictive of subsequent VPS insertion after aSAH. Although we could not identify modifiable risk factors for needing a VPS, nevertheless, these findings identify patients at greatest risk of VPS placement and inform treatment decisions as well as patient expectations.
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Affiliation(s)
- Michael K Tso
- Division of Neurosurgery, St. Michael's Hospital, Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital and Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - George M Ibrahim
- Division of Neurosurgery, St. Michael's Hospital, Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital and Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - R Loch Macdonald
- Division of Neurosurgery, St. Michael's Hospital, Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital and Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
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Erixon HO, Sorteberg A, Sorteberg W, Eide PK. Predictors of shunt dependency after aneurysmal subarachnoid hemorrhage: results of a single-center clinical trial. Acta Neurochir (Wien) 2014; 156:2059-69. [PMID: 25143185 DOI: 10.1007/s00701-014-2200-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 07/29/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hydrocephalus (HC) after aneurysmal subarachnoid hemorrhage (aSAH) is a common sequel. Proper selection of patients in need of permanent cerebrospinal fluid (CSF) diversion is, however, not straightforward. The aim of this study was to identify predictors of CSF shunt dependency following aSAH. METHODS We re-analyzed data acquired from aSAH patients previously enrolled in a prospective, controlled single-center clinical trial in which shunt dependency was not one of the end points. In the present study patients were allocated into two groups: those receiving a shunt (here denoted as shunt dependent) and those not receiving a shunt, based on a clinical decision process. Predictors of shunt dependency were identified by applying uni- and multivariable analysis. We tested a set of predefined possible risk factors based on the results of the clinical trial, including the impact of CSF drainage volume exceeding 1,500 ml during the 1st week after ictus. RESULTS Ninety patients were included in the study. Significant predictors of shunt dependency were poor clinical grade at admission [odds ratio (OR) 4.7, 95% confidence interval (CI) 1.2-18.4], large amounts of subarachnoid blood (OR 3.8, 95% CI 1.0-14.0), large ventricular size on preoperative cerebral computer tomographic (CT) scans (OR 1.0, 95% CI 1.0-1.1), and CSF volume drainage exceeding 1,500 ml during the 1st week after the ictus (OR 16.3, 95% CI 4.0-67.1). Age ≥70 years, larger amounts of intraventricular blood, vertebrobasilar aneurysm, and endovascular treatment tended to increase the likelihood of receiving a shunt. Outcome was not significantly different between shunted and non-shunted patients. CONCLUSIONS In this cohort of patients with clinical grade aSAH at admission, larger amounts of subarachnoid blood and large ventricular size on preoperative cerebral CT, and CSF drainage in excess of 1,500 ml during the 1st week after the ictus were significant predictors of shunt dependency. Shunt dependency did not hamper outcome.
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Lewis A, Irvine H, Ogilvy C, Kimberly WT. Predictors for delayed ventriculoperitoneal shunt placement after external ventricular drain removal in patients with subarachnoid hemorrhage. Br J Neurosurg 2014; 29:219-24. [DOI: 10.3109/02688697.2014.967753] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lewis A, Taylor Kimberly W. Prediction of ventriculoperitoneal shunt placement based on type of failure during external ventricular drain wean. Clin Neurol Neurosurg 2014; 125:109-13. [PMID: 25108289 DOI: 10.1016/j.clineuro.2014.07.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 05/31/2014] [Accepted: 07/20/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE There are multiple etiologies for failure while weaning an external ventricular drain (EVD) after subarachnoid hemorrhage (SAH), but there is little data on the relationship between etiology of wean failure and ventriculoperitoneal shunt (VPS) placement. METHODS We performed a retrospective analysis of SAH patients who had an EVD placed between January 2008 and June 2012 at our institution. For each wean step (defined as raising or clamping the EVD), we recorded success or failure. We categorized failure as lowering or opening the EVD due to elevated intracranial pressure (ICP), clinical failure (due to headache or vomiting or altered mental status), leakage from the EVD site, or development of radiographic hydrocephalus. We evaluated the relationship between etiology of wean failure and subsequent need for VPS. RESULTS Of 116 patients with an EVD placed, 35 required VPS placement (30%). Patients who required VPS placement had a median of 2 (interquartile range (IQR) 1-4) wean failures and those who did not require VPS placement had a median of 1 (IQR 0-1) wean failure (p=0.001). There was no significant relationship between age, sex, Hunt Hess score, Fisher score, Glasgow coma scale, aneurysm location, aneurysm size, aneurysm treatment method, vasospasm and need for VPS. There was a significant relationship between patients with at least one wean failure due to clinical changes or radiographic hydrocephalus and need for VPS (p=0.007 and p=0.029, respectively). After multivariate analysis, there was only a significant relationship between clinical changes and need for VPS (OR 2.76, CI 1.03-7.36, p=0.04). CONCLUSION There is a significant association between wean failure due to clinical changes and requirement for VPS placement after SAH.
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Affiliation(s)
- Ariane Lewis
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, USA.
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- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, USA.
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Klein AM, Howell K, Straube A, Pfefferkorn T, Bender A. Rehabilitation outcome of patients with severe and prolonged disorders of consciousness after aneurysmal subarachnoid hemorrhage (aSAH). Clin Neurol Neurosurg 2013; 115:2136-41. [DOI: 10.1016/j.clineuro.2013.08.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 07/23/2013] [Accepted: 08/04/2013] [Indexed: 12/21/2022]
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Ormond DR, Dressler A, Kim S, Ronecker J, Murali R. Lumbar drains may reduce the need for permanent CSF diversion in spontaneous subarachnoid haemorrhage. Br J Neurosurg 2012. [DOI: 10.3109/02688697.2012.743971] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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