| Objective : Chronic hydrocephalus is a common complication after aneurysmal subarachnoid hemorrhage(a SAH).Currently,there is a lock of data on the prognosis after shunt surgery of these patients.And most of the existing research focuses on the patients with shunt-dependent hydrocephalus(SDH)who have the symptoms of hydrocephalus,but less attention is paid to patients without symptoms.To observe the efficacy of Ventricle-Peritoneal shunt(VPS)in patients with chronic hydrocephalus after aneurysmal subarachnoid hemorrhage(a SAH)and analyze the data that related to patient’s outcome,especially those without the symptoms of hydrocephalus,hoping to further optimize the treatment of the patients with chronic hydrocephalus after a SAH.Method:The author performed a retrospective analysis of the patients,who underwent VPS surgery in the Second Affiliated Hospital of Zhejiang University School of Medicine,from January 2017 to June 2019.We analyzed the patients recorded clinical data,including age,gender,GCS and modified Rankin Scale(m RS)at admission,preoperative test of cerebrospinal fluid.The neurological prognosis evaluation [including m RS and Glasgow Outcome Scale(GOS)] of the patients were collected through telephone follow-up survey after 3 months later since patients were discharged.Correlation analysis was used to analyze the relationship between m RS grade and continuous data of the patients.Based on the follow-up m RS grade of the patient,m RS(0-2)was defined as favorable outcome group,and m RS(3-6)unfavorable outcome group,compared the general information and prognosis of anther two groups.Then the patients were divided into shunt-dependent hydrocephalus group(SDH group)and asymptomatic group(Non-SDH group)according to whether the patients had symptoms of hydrocephalus before surgery,including mental impairment,unstable balance,and urinary incontinence,compared the general information and prognosis of two groups.The proportion of patients who could live on their own after surgery based on GOS score was counted in the two groups.Results:59 patients were included in the analysis of surgical efficacy and prognosis,34 were male(57.6%),the mean age was(59.0 ± 9.1),and the mean follow-up time was(19.6 ± 8.5)months.Four patients died during the follow-up and 2 patients had the intracranial infection.The mean follow-up m RS score was(2.5 ± 1.7)points,improving about 1.0 points compared with m RS before VPS.Correlation analysis showed that there was no significant correlation between follow-up m RS scores and general clinical data such as age,BMI,pre-operative cerebrospinal fluid indexes,and follow-up time,and there was a negative correlation with GCS on admission(rs=-0.588,P <0.001),which means the lower the GCS on admission of the patients,the higher the follow-up m RS grade.Compared to the favorable and the unfavorable outcome group,there was no significant difference in baseline data between the two groups.But the m RS grade improvement in the unfavorable outcome group was significantly lower than the favorable outcome group(0.46±0.74 vs 1.43±1.09,P=0.001),the difference had statistically significant.The neurological evaluation on admission and follow-up in SDH group were better than Non-SDH group.Both the m RS grade in SDH and Non-SDH were significantly improved during follow-up,the degree of the improvement were similar(1.00±0.96 vs 1.13±1.20,P=0.640).However,the proportion of patients who couldn live on their own after surgery in the SDH group was higher than the Non-SDH group(75.9% vs 50.0%,P=0.040).Conclusion:VPS surgery can improve the long-term neurological outcome of patients with chronic hydrocephalus after a SAH.For patients with poor neurological evaluation before surgery,the function improvement may not be satisfied after shunt surgery.For patients who do not have symptoms of hydrocephalus before surgery,VPS surgery also has a positive effect,but the proportion of patients who could live on their own is lower. |
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