Cisternal Score: A Radiographic Score to Predict Ventriculoperitoneal Shunt Requirement in Aneurysmal Subarachnoid Hemorrhage.

Autor:	Meyer A; Brown University, Providence, Rhode Island, USA., Forman E; Brown University, Providence, Rhode Island, USA., Moody S; Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.; MGH Institute of Health Professions, Boston, Massachusetts, USA., Stretz C; Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA., Potter NS; Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.; Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA., Subramaniam T; Divisions of Neurocritical Care and Emergency Neurology, Yale University School of Medicine, New Haven, Connecticut, USA., Top I; Divisions of Neurocritical Care and Emergency Neurology, Yale University School of Medicine, New Haven, Connecticut, USA., Wendell LC; Division of Neurology, Mount Auburn Hospital, Cambridge, Massachusetts, USA., Thompson BB; Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.; Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA., Reznik ME; Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.; Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA., Furie KL; Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA., Mahta A; Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.; Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.; Section of Medical Education, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Jazyk:	angličtina
Zdroj:	Neurosurgery [Neurosurgery] 2023 Jul 01; Vol. 93 (1), pp. 75-83. Date of Electronic Publication: 2023 Jan 25.
DOI:	10.1227/neu.0000000000002374
Abstrakt:	Background: Persistent hydrocephalus requiring a ventriculoperitoneal shunt (VPS) can complicate the management of aneurysmal subarachnoid hemorrhage (aSAH). Identification of high-risk patients may guide external ventricular drain management. Objective: To identify early radiographic predictors for persistent hydrocephalus requiring VPS placement. Methods: In a 2-center retrospective study, we compared radiographic features on admission noncontrast head computed tomography scans of patients with aSAH requiring a VPS to those who did not, at 2 referral academic centers from 2016 through 2021. We quantified blood clot thickness in the basal cisterns including interpeduncular, ambient, crural, prepontine, interhemispheric cisterns, and bilateral Sylvian fissures. We then created the cisternal score (CISCO) using features that were significantly different between groups. Results: We included 229 survivors (mean age 55.6 years [SD 13.1]; 63% female) of whom 50 (22%) required VPS. CISCO was greater in patients who required a VPS than those who did not (median 4, IQR 3-6 vs 2, IQR 1-4; P < .001). Higher CISCO was associated with higher odds of developing persistent hydrocephalus with VPS requirement (odds ratio 1.6 per point increase, 95% CI 1.34-1.9; P < .001), independent of age, Hunt and Hess grades, and modified GRAEB scores. CISCO had higher accuracy in predicting VPS requirement (area under the curve 0.75, 95% CI 0.68-0.82) compared with other predictors present on admission. Conclusion: Cisternal blood clot quantification on admission noncontrast head computed tomography scan is feasible and can be used in predicting persistent hydrocephalus with VPS requirement in patients with aSAH. Future prospective studies are recommended to further validate this tool. (Copyright © Congress of Neurological Surgeons 2023. All rights reserved.)
Databáze:	MEDLINE
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