Journal of Cerebrovascular and Endovascular Neurosurgery

  • 제20권2호
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  • Pages.87-95
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  • 2018
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  • 2234-8565(pISSN)
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  • 2287-3139(eISSN)
대한뇌혈관외과학회 (Korean Society of Cerebravascular Surgeons)
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Does Neurosurgical Clipping or Endovascular Coiling Lead to More Cases of Delayed Hydrocephalus in Patients with Subarachnoid Hemorrhage?

  • Eom, Tae Oong (Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Park, Eun Suk (Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Park, Jun Bum (Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Kwon, Soon Chan (Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Sim, Hong Bo (Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Lyo, In Uk (Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Kim, Min Soo (Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine)
  • 투고 : 2018.03.26
  • 심사 : 2018.05.20
  • 발행 : 2018.06.30
⟨ 이전 논문 다음 논문 ⟩

초록

Objective : We investigated whether clipping or endovascular treatment (EVT) can reduce the incidence of delayed hydrocephalus. We also investigated whether additional procedures, namely lumbar drainage and extra-ventricular drainage (EVD), decrease the incidence of delayed hydrocephalus in patients with subarachnoid hemorrhage (SAH). Materials and Methods : One-hundred and fifty-two patients who had undergone an operation for SAH were enrolled in this study. Clinical data, radiological data, and procedural data were investigated. Procedural data included the operating technique (clipping vs. EVT) and the use of additional procedures (no procedure, lumbar drainage, or EVD). Delayed hydrocephalus was defined as a condition in which the Evan's index was 0.3 or higher, as assessed using brain computed tomography more than 2 weeks after surgery, requiring shunt placement due to neurological deterioration. Results : Of the 152 patients, 45 (29.6%) underwent surgical clipping and 107 (70.4%) underwent EVT. Twenty-five (16.4%) patients developed delayed hydrocephalus. Age (p = 0.019), procedure duration (p = 0.004), and acute hydrocephalus (p = 0.030) were significantly correlated with the incidence of delayed hydrocephalus. However, the operation technique (p = 0.593) and use of an additional procedure (p = 0.378) were not significantly correlated with delayed hydrocephalus incidence. Conclusion : No significant difference in the incidence of delayed hydrocephalus was associated with operation technique or use of an additional procedure in patients with SAH. However, delayed hydrocephalus was significantly correlated with old age, long procedural duration, and acute hydrocephalus. Therefore, we recommend that additional procedures should be discontinued as soon as possible.

키워드

과제정보

연구 과제 주관 기관 : National Research Foundation of Korea (NRF)

참고문헌

  1. Al-Tamimi YZ, Bhargava D, Feltbower RG, Hall G, Goddard AJ, Quinn AC, et al. Lumbar drainage of cerebrospinal fluid after aneurysmal subarachnoid hemorrhage: a prospective, randomized, controlled trial (LUMAS). Stroke. 2012 Mar;43(3):677-82. https://doi.org/10.1161/STROKEAHA.111.625731
  2. Auer LM, Mokry M. Disturbed cerebrospinal fluid circulation after subarachnoid hemorrhage and acute aneurysm surgery. Neurosurgery. 1990 May;26(5):804-8; discussion 808-9. https://doi.org/10.1227/00006123-199005000-00012
  3. Byoun HS, Yi HJ, Choi KS, Chun HJ, Ko Y, Bak KH. Comparison of endovascular treatments of ruptured dissecting aneurysms of the intracranial internal carotid artery and vertebral artery with a review of the literature. J Korean Neurosurg Soc. 2016 Sep;59(5):449-57. https://doi.org/10.3340/jkns.2016.59.5.449
  4. Choi JH, Park JE, Kim MJ, Kim BS, Shin YS. Aneurysmal neck clipping as the primary treatment option for both ruptured and unruptured middle cerebral artery aneurysms. J Korean Neurosurg Soc. 2016 May;59(3):269-75. https://doi.org/10.3340/jkns.2016.59.3.269
  5. Connolly ES Jr, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. Stroke. 2012 Jun;43(6):1711-37. https://doi.org/10.1161/STR.0b013e3182587839
  6. Degos V, Gourraud PA, Tursis VT, Whelan R, Colonne C, Korinek AM, et al. Elderly age as a prognostic marker of 1-year poor outcome for subarachnoid hemorrhage patients through its interaction with admission hydrocephalus. Anesthesiology. 2012 Dec;117(6):1289-99. https://doi.org/10.1097/ALN.0b013e318267395b
  7. Dorai Z, Hynan LS, Kopitnik TA, Samson D. Factors related to hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery. 2003 Apr;52(4):763-9; discussion 769-71. https://doi.org/10.1227/01.NEU.0000053222.74852.2D
  8. Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery. 1980 Jan;6(1):1-9. https://doi.org/10.1227/00006123-198001000-00001
  9. Gonzalez NR, Boscardin WJ, Glenn T, Vinuela F, Martin NA. Vasospasm probability index: a combination of transcranial doppler velocities, cerebral blood flow, and clinical risk factors to predict cerebral vasospasm after aneurysmal subarachnoid hemorrhage. J Neurosurg. 2007 Dec;107(6):1101-12. https://doi.org/10.3171/JNS-07/12/1101
  10. Gruber A, Reinprecht A, Bavinzski G, Czech T, Richling B. Chronic shunt-dependent hydrocephalus after early surgical and early endovascular treatment of ruptured intracranial aneurysms. Neurosurgery. 1999 Mar;44(3):503-9; discussion 509-12. https://doi.org/10.1097/00006123-199903000-00039
  11. Hirashima Y, Hamada H, Hayashi N, Kuwayama N, Origasa H, Endo S. Independent predictors of late hydrocephalus in patients with aneurysmal subarachnoid hemorrhage--analysis by multivariate logistic regression model. Cerebrovasc Dis. 2003;16(3):205-10. https://doi.org/10.1159/000071117
  12. Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg. 1968 Jan;28(1):14-20. https://doi.org/10.3171/jns.1968.28.1.0014
  13. Jartti P, Karttunen A, Jartti A, Ukkola V, Sajanti J, Pyhtinen J. Factors related to acute hydrocephalus after subarachnoid hemorrhage. Acta Radiol. 2004 May;45(3):333-9. https://doi.org/10.1080/02841850410004274
  14. Kasuya H, Shimizu T, Kagawa M. The effect of continuous drainage of cerebrospinal fluid in patients with subarachnoid hemorrhage: a retrospective analysis of 108 patients. Neurosurgery. 1991 Jan;28(1):56-9. https://doi.org/10.1227/00006123-199101000-00009
  15. Lanzino G, Kassell NF, Germanson TP, Kongable GL, Truskowski LL, Torner JC, et al. Age and outcome after aneurysmal subarachnoid hemorrhage: why do older patients fare worse? J Neurosurg. 1996 Sep;85(3):410-8. https://doi.org/10.3171/jns.1996.85.3.0410
  16. Lawton MT, Vates GE. Subarachnoid hemorrhage. N Engl J Med. 2017 Jul 20;377(3):257-66. https://doi.org/10.1056/NEJMcp1605827
  17. Molyneux AJ, Kerr RS, Yu LM, Clarke M, Sneade M, Yarnold JA, et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet. 2005 Sep 3-9;366(9488):809-17. https://doi.org/10.1016/S0140-6736(05)67214-5
  18. Ohwaki K, Yano E, Nakagomi T, Tamura A. Relationship between shunt-dependent hydrocephalus after subarachnoid haemorrhage and duration of cerebrospinal fluid drainage. Br J Neurosurg. 2004 Apr;18(2):130-4. https://doi.org/10.1080/02688690410001680975
  19. Otawara Y, Ogasawara K, Kubo Y, Sasoh M, Ogawa A. Effect of continuous cisternal cerebrospinal fluid drainage for patients with thin subarachnoid hemorrhage. Vasc Health Risk Manag. 2007;3(4):401-4.
  20. Park S, Yang N, Seo E. The effectiveness of lumbar cerebrospinal fluid drainage to reduce the cerebral vasospasm after surgical clipping for aneurysmal subarachnoid hemorrhage. J Korean Neurosurg Soc. 2015 Mar;57(3):167-73 https://doi.org/10.3340/jkns.2015.57.3.167
  21. Rosen DS, Macdonald RL, Huo D, Goldenberg FD, Novakovic RL, Frank JI, et al. Intraventricular hemorrhage from ruptured aneurysm: clinical characteristics, complications, and outcomes in a large, prospective, multicenter study population. J Neurosurg. 2007 Aug;107(2):261-5. https://doi.org/10.3171/JNS-07/08/0261
  22. Schirmer CM, Hoit DA, Malek AM. Decompressive hemicraniectomy for the treatment of intractable intracranial hypertension after aneurysmal subarachnoid hemorrhage. Stroke. 2007 Mar;38(3):987-92. https://doi.org/10.1161/01.STR.0000257962.58269.e2
  23. Spetzler RF, McDougall CG, Zabramski JM, Albuquerque FC, Hills NK, Russin JJ, et al. The barrow ruptured aneurysm trial: 6-year results. J Neurosurg. 2015 Sep;123(3):609-17. https://doi.org/10.3171/2014.9.JNS141749
  24. Sun C, Du H, Yin L, He M, Tian Y, Li H. Choice for the removal of bloody cerebrospinal fluid in postcoiling aneurysmal subarachnoid hemorrhage: external ventricular drainage or lumbar drainage? Turk Neurosurg. 2014;24(5):737-44. https://doi.org/10.5137/1019-5149.JTN.9837-13.2
  25. Toma AK, Holl E, Kitchen ND, Watkins LD. Evans' index revisited: the need for an alternative in normal pressure hydrocephalus. Neurosurgery. 2011 Apr;68(4):939-44. https://doi.org/10.1227/NEU.0b013e318208f5e0
  26. Vale FL, Bradley EL, Fisher WS 3rd. The relationship of subarachnoid hemorrhage and the need for postoperative shunting. J Neurosurg. 1997 Mar;86(3):462-6. https://doi.org/10.3171/jns.1997.86.3.0462
  27. Vassilouthis J, Richardson AE. Ventricular dilatation and communicating hydrocephalus following spontaneous subarachnoid hemorrhage. J Neurosurg. 1979 Sep;51(3):341-51. https://doi.org/10.3171/jns.1979.51.3.0341
  28. Wartenberg KE, Schmidt JM, Claassen J, Temes RE, Frontera JA, Ostapkovich N, et al. Impact of medical complications on outcome after subarachnoid hemorrhage. Crit Care Med. 2006 Mar;34(3):617-23; quiz 624. https://doi.org/10.1097/01.CCM.0000201903.46435.35
  29. Wilson JT, Hareendran A, Grant M, Baird T, Schulz UG, Muir KW, et al. Improving the assessment of outcomes in stroke: use of a structured interview to assign grades on the modified rankin scale. Stroke. 2002 Sep;33(9):2243-6. https://doi.org/10.1161/01.STR.0000027437.22450.BD