Acute Hydrocephalus and Chronic Hydrocephalus with the need of Postoperative Shunting after Aneurysmal Subarachnoid Hemorrhage

動脈瘤破裂引發蜘蛛網膜下腔出血後的急性水腦及慢性水腦需術後腦室腹腔引流

林志隆(Chih-Lung Lin) ； 關皚麗 (Aij-Lie Kwan) ； 洪純隆(Shen-Long Howng)

《The Kaohsiung Journal of Medical Sciences》 15卷3期 (1999/03) Pp. 137-145

https://doi.org/10.6452/KJMS.199903.0137

摘要

我們追蹤6年間168位蜘蛛網膜下腔出血接受動脈瘤手徑的病人，追蹤時間從6個月到77個月（平均38個月）。急性水腦定義為出血後72小時內bicaudate index大於同年齡層的百分之九十五以上。共有40位病人（24％）發現有急性水入院時的Hunt and Hess；　Fisher等級、腦室內出血、有症狀的血管厥戀及腦脊髓液引流都與急性水腦有有意義的相關。追蹤時的總體死亡率為16％。存活下來的141位病人，20位（14％）因慢性水腦需腦室腹腔引流。我們發現年齡、急性水腦、入院時的Hunt and Hess、Fisher 等級及腦脊髓液引流都與慢性水腦需腦室腹腔引流有有意義的相關。沒有病人在出血後117天以後再接受腦室腹腔引流。有急性水腦的病人伴有高死亡率（28％）。40位有急性水腦的病人，29位存活下來，其中10位需腦室腹腔引流。但無急性水腦的病人小於10％需腦室腹腔引流。我們建議追蹤蜘蛛網膜下腔出血接受動脈瘤手術的病人至少6個月，尤其是有發生慢性水腦高危險群一的病人。針對有發生急性水腦高危險群的病人，要密切觀察，盡早診斷，積極治療以減低其高死亡率。

並列摘要

During a 6-year period, 168 consecutive patients who presented with subarachnoid hemorrhage (SAH) and underwent surgical clipping of aneurysms were reviewed at a follow-up examination from 6 to 77 months (mean 38 months) after the ictus. Acute hydrocephalus was defined when the bicaudate index was greater than the 95th percentile for age on a computed tomographic scan within 72 hours of the hemorrhage. Forty (24%) patients developed acute hydrocepalus. The Hunt and Hess grades and Fisher’s SAH grades at the time of admission, the presence of intraventricular hemorrhage and symptomatic cerebral vasospasm, and cerebrospinal fluid (CSF) diversion were found to be significantly associated with acutehydrocephalus. The overall mortality in this study was 16%. Of the 141 surviving patients, 20(14%) patients underwent ventriculoperitoneal (VP) shunt replacement secondary to chronic hydrocephalus. In the present study, we found that the following factors were significantly related to the need of VP shunting:increasing age, the presence of acute hydrocephalus, preoperative CSF diversion, low admission Hunt and Hess grades, and poor Fisher’s SAH grades. No patient was readmitted for shunt replacement at our hospital later than 117 days after hemorrhage. Acute hydrocephalus was combined with high mortality (28%) at our follow-up review. Ten of 29 (34%) patients with acute hydrocephalus required definite shunt replacement. However. Less than 10% of patients without acute hydrocephalus needed shunting postoperatively. We recommend that patients with aneurismal SAH should be followed up at least 6 months after the hemorrhage, especially in those patients with high risks of developing chronic hydrocephalus.

並列關鍵字

subarachnoid hemorrhage ； hydrocephalus ； VP shunt