Risk Factors and Preoperative Risk Scoring System for Shunt-Dependent Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage

Kim, Joo Hyun; Kim, Jae Hoon; Kang, Hee In; Kim, Deok Ryeong; Moon, Byung Gwan; Kim, Joo Seung

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자료유형: 학술저널

저자정보: Kim, Joo Hyun (Department of Neurosurgery, Eulji University Eulji Hospital) Kim, Jae Hoon (Department of Neurosurgery, Eulji University Eulji Hospital) Kang, Hee In (Department of Neurosurgery, Eulji University Eulji Hospital) Kim, Deok Ryeong (Department of Neurosurgery, Eulji University Eulji Hospital) Moon, Byung Gwan (Department of Neurosurgery, Eulji University Eulji Hospital) Kim, Joo Seung (Department of Neurosurgery, Eulji University Eulji Hospital)

저널정보: 대한신경외과학회 대한신경외과학회지 대한신경외과학회지 제62권 제6호

발행연도: 2019.1

수록면: 643 - 648 (6page)

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Objective : Shunt-dependent hydrocephalus (SdHCP) is a well-known complication of aneurysmal subarachnoid hemorrhage (SAH). The risk factors for SdHCP have been widely investigated, but few risk scoring systems have been established to predict SdHCP. This study was performed to investigate the risk factors for SdHCP and devise a risk scoring system for use before aneurysm obliteration. Methods : We reviewed the data of 301 consecutive patients who underwent aneurysm obliteration following SAH from September 2007 to December 2016. The exclusion criteria for this study were previous aneurysm obliteration, previous major cerebral infarction, the presence of a cavum septum pellucidum, a midline shift of >10 mm on initial computed tomography (CT), and in-hospital mortality. We finally recruited 254 patients and analyzed the following data according to the presence or absence of SdHCP : age, sex, history of hypertension and diabetes mellitus, Hunt-Hess grade, Fisher grade, aneurysm size and location, type of treatment, bicaudate index on initial CT, intraventricular hemorrhage, cerebrospinal fluid drainage, vasospasm, and modified Rankin scale score at discharge. Results : In the multivariate analysis, acute HCP (bicaudate index of ${\geq}0.2$) (odds ratio [OR], 6.749; 95% confidence interval [CI], 2.843-16.021; p=0.000), Fisher grade of 4 (OR, 4.108; 95% CI, 1.044-16.169; p=0.043), and an age of ${\geq}50years$ (OR, 3.938; 95% CI, 1.375-11.275; p=0.011) were significantly associated with the occurrence of SdHCP. The risk scoring system using above parameters of acute HCP, Fisher grade, and age (AFA score) assigned 1 point to each (total score of 0-3 points). SdHCP occurred in 4.3% of patients with a score of 0, 8.5% with a score of 1, 25.5% with a score of 2, and 61.7% with a score of 3 (p=0.000). In the receiver operating characteristic curve analysis, the area under the curve (AUC) for the risk scoring system was 0.820 (p=0.080; 95% CI, 0.750-0.890). In the internal validation of the risk scoring system, the score reliably predicted SdHCP (AUC, 0.895; p=0.000; 95% CI, 0.847-0.943). Conclusion : Our results suggest that the herein-described AFA score is a useful tool for predicting SdHCP before aneurysm obliteration. Prospective validation is needed.

#Aneurysm #Hydrocephalus #Subarachnoid hemorrhage #Ventriculoperitoneal shunt

참고문헌 (23)

참고문헌 신청

Adams H / 2016 / Risk of shunting after aneurysmal subarachnoid hemorrhage: a collaborative study and initiation of a consortium / Stroke 47:2488~2496

배인석 / 2014 / Comparison of Incidence and Risk Factors for Shunt-dependent Hydrocephalus in Aneurysmal Subarachnoid Hemorrhage Patients / Journal of Cerebrovascular and Endovascular Neurosurgery 16(2):78~84

Chan M / 2009 / Prediction of ventriculoperitoneal shunt dependency in patients with aneurysmal subarachnoid hemorrhage / J Neurosurg 110:44~49

Diesing D / 2018 / A novel score to predict shunt dependency after aneurysmal subarachnoid hemorrhage / J Neurosurg 128:1273~1279

Dorai Z / 2003 / Factors related to hydrocephalus after aneurysmal subarachnoid hemorrhage / Neurosurgery 52:763~769

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