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Optimal intracranial pressure in patients with aneurysmal subarachnoid hemorrhage treated with coiling and requiring external ventricular drainage.
Neurosurgical Review ( IF 2.8 ) Pub Date : 2020-05-27 , DOI: 10.1007/s10143-020-01322-2 Federico Cagnazzo 1 , Kevin Chalard 2 , Pierre-Henri Lefevre 1 , Ocean Garnier 2 , Imad Derraz 1 , Cyril Dargazanli 1 , Gregory Gascou 1 , Carlos Riquelme 1 , Alain Bonafe 1 , Paolo Perrini 3 , Davide Tiziano Di Carlo 3 , Riccardo Morganti 4 , Marine Le Corre 5 , Frederique Pavillard 2 , Pierre-Francois Perrigault 2 , Vincent Costalat 1
Neurosurgical Review ( IF 2.8 ) Pub Date : 2020-05-27 , DOI: 10.1007/s10143-020-01322-2 Federico Cagnazzo 1 , Kevin Chalard 2 , Pierre-Henri Lefevre 1 , Ocean Garnier 2 , Imad Derraz 1 , Cyril Dargazanli 1 , Gregory Gascou 1 , Carlos Riquelme 1 , Alain Bonafe 1 , Paolo Perrini 3 , Davide Tiziano Di Carlo 3 , Riccardo Morganti 4 , Marine Le Corre 5 , Frederique Pavillard 2 , Pierre-Francois Perrigault 2 , Vincent Costalat 1
Affiliation
Optimal management of intracranial pressure (ICP) among aneurysmal subarachnoid hemorrhage (aSAH) patients requiring external ventricular drainage (EVD) is controversial. To analyze predictors of delayed cerebral ischemia (DCI)-related cerebral infarction after aSAH and the influence of ICP values on DCI, we prospectively collected consecutive patients with aSAH receiving coiling and requiring EVD. Predictors of DCI-related cerebral infarction (new CT hypodensities developed within the first 3 weeks not related to other causes) were studied. Vasospasm and brain hypoperfusion were studied with CT angiography and CT perfusion (RAPID-software). Among 50 aSAH patients requiring EVD, 21 (42%) developed DCI-related cerebral infarction, while 27 (54%) presented vasospasm. Mean ICP ranged between 2 and 19 mmHg. On the multivariate analysis, the mean ICP (OR = 2, 95%CI = 1.01-3.9, p = 0.042) and the mean hypoperfusion volume on Tmax delay > 6 (OR = 1.2, 95%CI = 1.01-1.3, p = 0.025) were independent predictors of DCI. To predict DCI-related cerebral infarction, Tmax delay > 6 s presented the highest AUC (0.956, SE = 0.025), with a cutoff value of 18 ml showing sensitivity, specificity, PPV, NPV, and accuracy of 90.5% (95%CI = 69-98.8%), 86.2% (95%CI = 68.4-96%), 82.6% (95%CI = 65.4-92%), 92.5% (95%CI = 77-98%), and 88% (95%CI = 75-95%), respectively. The AUC of the mean ICP was 0.825 (SE = 0.057), and the best cutoff value was 6.7 mmHg providing sensitivity, specificity, PPV, NPV, and accuracy of 71.4% (95%CI = 48-89%), 62% (95%CI = 42-79%), 58% (95%CI = 44-70%), 75% (95%CI = 59-86%), and 66% (95%CI = 51-79%) for the prediction of DCI-related cerebral infarction, respectively. Among aSAH patients receiving coiling and EVD, lower ICP (< 6.7 mmHg in our study) could potentially be beneficial in decreasing DCI-related cerebral infarction. Brain hypoperfusion with a volume > 18 ml at Tmax delay > 6 s presents a high sensibility and specificity in prediction of DCI-related cerebral infarction.
中文翻译：
盘绕治疗并需要外部心室引流的动脉瘤性蛛网膜下腔出血患者的最佳颅内压。
需要外部心室引流（EVD）的动脉瘤性蛛网膜下腔出血（aSAH）患者的颅内压（ICP）最佳管理存在争议。为了分析aSAH后延迟性脑缺血（DCI）相关性脑梗死的预测因素以及ICP值对DCI的影响，我们前瞻性收集了连续连续且需要EVD的aSAH患者。研究了DCI相关性脑梗死（前3周内出现新的CT低密度与其他原因无关）的预测因素。通过CT血管造影和CT灌注（RAPID软件）研究了血管痉挛和脑灌注不足。在50名需要EVD的aSAH患者中，有21名（42％）发生了DCI相关的脑梗死，而27名（54％）出现了血管痉挛。ICP的平均范围为2至19 mmHg。在多元分析中 独立的预测因子是平均ICP（OR = 2，95％CI = 1.01-3.9，p = 0.042）和Tmax延迟> 6时的平均低灌注量（OR = 1.2，95％CI = 1.01-1.3，p = 0.025） DCI。为了预测DCI相关的脑梗塞，Tmax延迟> 6 s表示最高的AUC（0.956，SE = 0.025），临界值为18 ml，表明敏感性，特异性，PPV，NPV和90.5％（95％CI）的准确性= 69-98.8％），86.2％（95％CI = 68.4-96％），82.6％（95％CI = 65.4-92％），92.5％（95％CI = 77-98％）和88％（ 95％CI = 75-95％）。ICP的平均AUC为0.825（SE = 0.057），最佳截止值为6.7 mmHg，灵敏度，特异性，PPV，NPV和准确度分别为71.4％（95％CI = 48-89％），62％（ 95％CI = 42-79％），58％（95％CI = 44-70％），75％（95％CI = 59-86％）和66％（95％CI = 51-79％）分别预测与DCI相关的脑梗塞。在接受盘绕和EVD的aSAH患者中，较低的ICP（在我们的研究中<6.7 mmHg）可能对减少DCI相关的脑梗死有潜在的益处。Tmax延迟> 6 s时容量> 18 ml的脑灌注不足，在预测DCI相关性脑梗死方面具有很高的敏感性和特异性。
更新日期：2020-05-27
中文翻译：
盘绕治疗并需要外部心室引流的动脉瘤性蛛网膜下腔出血患者的最佳颅内压。
需要外部心室引流（EVD）的动脉瘤性蛛网膜下腔出血（aSAH）患者的颅内压（ICP）最佳管理存在争议。为了分析aSAH后延迟性脑缺血（DCI）相关性脑梗死的预测因素以及ICP值对DCI的影响，我们前瞻性收集了连续连续且需要EVD的aSAH患者。研究了DCI相关性脑梗死（前3周内出现新的CT低密度与其他原因无关）的预测因素。通过CT血管造影和CT灌注（RAPID软件）研究了血管痉挛和脑灌注不足。在50名需要EVD的aSAH患者中，有21名（42％）发生了DCI相关的脑梗死，而27名（54％）出现了血管痉挛。ICP的平均范围为2至19 mmHg。在多元分析中 独立的预测因子是平均ICP（OR = 2，95％CI = 1.01-3.9，p = 0.042）和Tmax延迟> 6时的平均低灌注量（OR = 1.2，95％CI = 1.01-1.3，p = 0.025） DCI。为了预测DCI相关的脑梗塞，Tmax延迟> 6 s表示最高的AUC（0.956，SE = 0.025），临界值为18 ml，表明敏感性，特异性，PPV，NPV和90.5％（95％CI）的准确性= 69-98.8％），86.2％（95％CI = 68.4-96％），82.6％（95％CI = 65.4-92％），92.5％（95％CI = 77-98％）和88％（ 95％CI = 75-95％）。ICP的平均AUC为0.825（SE = 0.057），最佳截止值为6.7 mmHg，灵敏度，特异性，PPV，NPV和准确度分别为71.4％（95％CI = 48-89％），62％（ 95％CI = 42-79％），58％（95％CI = 44-70％），75％（95％CI = 59-86％）和66％（95％CI = 51-79％）分别预测与DCI相关的脑梗塞。在接受盘绕和EVD的aSAH患者中，较低的ICP（在我们的研究中<6.7 mmHg）可能对减少DCI相关的脑梗死有潜在的益处。Tmax延迟> 6 s时容量> 18 ml的脑灌注不足，在预测DCI相关性脑梗死方面具有很高的敏感性和特异性。
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