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Ma Y, Bu L, Wu D, Wang K, Zhou H. Hydrocephalus in primary brainstem hemorrhage risk predictors and management. Sci Rep 2025; 15:1842. [PMID: 39805926 PMCID: PMC11730966 DOI: 10.1038/s41598-025-86060-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Accepted: 01/08/2025] [Indexed: 01/16/2025] Open
Abstract
This study explored the risk factors associated with hydrocephalus incidence and evaluated the effectiveness of surgical treatments in managing this condition. Patients with PBSH were retrospectively evaluated, identifying clinical and radiological characteristics. A multivariate logistic regression model was used for analyses. Of the 169 patients studied, 77 developed hydrocephalus. Midbrain hemorrhage, tegmental pons hemorrhage, disappearance of annular cisterna, combined cerebellar and intraventricular hematoma increased the risk of hydrocephalus (p < 0.05). A linear relationship was found between hematoma volume and hydrocephalus, with a volume > 6.1 mL associated with a higher risk. Patients with ≥ 2 the following factors: multiple hematoma sites, intraventricular hematoma, or hematoma volume > 6.1 mL, had a significantly increased risk of hydrocephalus. Forty-seven patients received surgical treatments including stereotactic puncture drainage of hematoma (SPDH) or external ventricular drainage (EVD). Both SPDH and EVD were effective in treating hydrocephalus (p < 0.001). The combination of SPDH and EVD showed the greatest benefit (p < 0.001); 30-day mortality and de-ventilator rates in the surgical group were significantly different from the non-surgical group. This finding provides valuable insights for early surgical intervention in patients with PBSH.
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Affiliation(s)
- Yuehui Ma
- Department of Neurosurgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, China.
| | - Linghao Bu
- Department of Neurosurgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, China
| | - Dengchang Wu
- Department of Neurology, The First Affiliated Hospital, School of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, China
| | - Kang Wang
- Department of Neurology, The First Affiliated Hospital, School of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, China
| | - Hengjun Zhou
- Department of Neurosurgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No.79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, China
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Zhang F, Cai XF, Zhao W, Wang YH, He JQ. A Predictive Model for Chronic Hydrocephalus After Clipping Aneurysmal Subarachnoid Hemorrhage. J Craniofac Surg 2023; 34:680-683. [PMID: 36168119 DOI: 10.1097/scs.0000000000009036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/25/2022] [Indexed: 11/26/2022] Open
Abstract
Chronic hydrocephalus after clipping aneurysmal subarachnoid hemorrhage (aSAH) often results in poor outcomes. This study was to establish and validate model to predict chronic hydrocephalus after aSAH by least absolute shrinkage and selection operator logistic regression. The model was constructed from a retrospectively analyzed. Two hundred forty-eight patients of aSAH were analyzed retrospectively in our hospital from January 2019 to December 2021, and the patients were divided into chronic hydrocephalus (CH) group (n=55) and non-CH group (n=193) according to whether occurred CH within 3 months. In summary, 16 candidate risk factors related to chronic hydrocephalus after aSAH were analyzed. Univariate analysis was performed to judging the risk factors for CH. The least absolute shrinkage and selection operator regression was used to filter risk factors. Subsequently, the nomogram was designed by the above variables. And area under the curve and calibration chart were used to detect the discrimination and goodness of fit of the nomogram, respectively. Finally, decision curve analysis was constructed to assess the practicability of the risk of chronic hydrocephalus by calculating the net benefits. Univariate analysis showed that age (60 y or older), aneurysm location, modified Fisher grade, Hunt-Hess grade, and the method for cerebrospinal fluid drainage, intracranial infections, and decompressive craniectomy were significantly related to CH ( P <0.05). Whereas 5 variables [age (60 y or older), posterior aneurysm, modified Fisher grade, Hunt-Hess grade, decompression craniectomy] from 16 candidate factors were filtered by LASSO logistic regression for further research. Area under the curve of this model was 0.892 (95% confidence interval: 0.799-0.981), indicating a good discrimination ability. Meanwhile, the result of calibration indicated a good fitting between the prediction probability and the actual probability. Finally, decision curve analysis showed a good clinical efficacy. In summary, this model could conveniently predict the occurrence of chronic hydrocephalus after aSAH. Meanwhile, it could help physicians to develop personalized treatment and close follow-up for these patients.
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Affiliation(s)
- Feng Zhang
- Department of Neurosurgery, 904st Hospital of The People's Liberation Army, Wuxi, Jiangsu, China
- Department of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong
| | - Xian-Feng Cai
- Department of Neurosurgery, 904st Hospital of The People's Liberation Army, Wuxi, Jiangsu, China
| | - Wei Zhao
- Department of Neurosurgery, 904st Hospital of The People's Liberation Army, Wuxi, Jiangsu, China
| | - Yu-Hai Wang
- Department of Neurosurgery, 904st Hospital of The People's Liberation Army, Wuxi, Jiangsu, China
| | - Jian-Qing He
- Department of Neurosurgery, 904st Hospital of The People's Liberation Army, Wuxi, Jiangsu, China
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Shen D, Ye X, Li J, Hao X, Jin L, Jin Y, Tong L, Gao F. Metformin Preserves VE–Cadherin in Choroid Plexus and Attenuates Hydrocephalus via VEGF/VEGFR2/p-Src in an Intraventricular Hemorrhage Rat Model. Int J Mol Sci 2022; 23:ijms23158552. [PMID: 35955686 PMCID: PMC9369137 DOI: 10.3390/ijms23158552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 02/04/2023] Open
Abstract
Hydrocephalus induced by intraventricular hemorrhage (IVH) is associated with unfavorable prognosis. The increased permeability of choroid plexus and breakdown of the blood–brain barrier (BBB) was reported as a prominent mechanism of IVH-induced hydrocephalus, and vascular endothelial–cadherin (VE–cadherin) was demonstrated to be relevant. Metformin was reported to protect endothelial junction and preserve permeability widely; however, its role in hydrocephalus remains unclear. In this study, the decreased expression of VE–cadherin in the choroid plexus, accompanied with ventricle dilation, was investigated in an IVH rat model induced by intraventricular injection of autologous blood. Metformin treatment ameliorated hydrocephalus and upregulated VE–cadherin expression in choroid plexus meanwhile. We then observed that the internalization of VE–cadherin caused by the activation of vascular endothelial growth factor (VEGF) signaling after IVH was related to the occurrence of hydrocephalus, whereas it can be reversed by metformin treatment. Restraining VEGF signaling by antagonizing VEGFR2 or inhibiting Src phosphorylation increased the expression of VE–cadherin and decreased the severity of hydrocephalus after IVH. Our study demonstrated that the internalization of VE–cadherin via the activation of VEGF signaling may contribute to IVH-induced hydrocephalus, and metformin may be a potential protector via suppressing this pathway.
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Affiliation(s)
- Dan Shen
- Department of Neurology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; (D.S.); (X.Y.); (J.L.); (X.H.); (L.J.); (Y.J.)
| | - Xianghua Ye
- Department of Neurology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; (D.S.); (X.Y.); (J.L.); (X.H.); (L.J.); (Y.J.)
| | - Jiawen Li
- Department of Neurology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; (D.S.); (X.Y.); (J.L.); (X.H.); (L.J.); (Y.J.)
| | - Xiaodi Hao
- Department of Neurology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; (D.S.); (X.Y.); (J.L.); (X.H.); (L.J.); (Y.J.)
- Department of Neurology, Henan Province People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Luhang Jin
- Department of Neurology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; (D.S.); (X.Y.); (J.L.); (X.H.); (L.J.); (Y.J.)
| | - Yujia Jin
- Department of Neurology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; (D.S.); (X.Y.); (J.L.); (X.H.); (L.J.); (Y.J.)
| | - Lusha Tong
- Department of Neurology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; (D.S.); (X.Y.); (J.L.); (X.H.); (L.J.); (Y.J.)
- Correspondence: (L.T.); (F.G.)
| | - Feng Gao
- Department of Neurology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China; (D.S.); (X.Y.); (J.L.); (X.H.); (L.J.); (Y.J.)
- Correspondence: (L.T.); (F.G.)
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Wang FB, Yuan XW, Li JX, Zhang M, Xiang ZH. Endoscopic surgery for intraventricular hemorrhage: A comparative study and single center surgical experience. World J Clin Cases 2022; 10:5208-5216. [PMID: 35812683 PMCID: PMC9210893 DOI: 10.12998/wjcc.v10.i16.5208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 01/19/2022] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intraventricular hemorrhage is a neurosurgical emergency, and a dangerous condition associated with high morbidity and mortality. Previously, hematoma evacuation is generally executed by external intracranial drainage (EVD) or surgical evacuation. Nowadays, endoscopic evacuation is emerging as a good alternative because it brings relatively less invasion and injury. However, successful endoscopic evacuation requires skilled manipulation of endoscopic devices and the evidence supporting its efficacy differs in different reports.
AIM To improve the technique usage and provide more evidence of endoscopic evacuation efficacy, we summarize our surgical experience and compared the outcomes of the endoscopic evacuation with EVD using real-world data.
METHODS We retrospectively studied 96 consecutive patients with intraventricular hemorrhage who underwent either endoscopic surgery (n = 43) or non-endoscopic surgery (n = 53) for hemorrhage evacuation between November 2013 and September 2019 in our center. Patients’ conditions prior to and after the operation were evaluated and analyzed to assess the efficacy of the operation. The consciousness status improvement and perioperative in-hospital parameters in the two types of operation groups were assessed and compared.
RESULTS Patients in the endoscopic and non-endoscopic groups presented with a similar state of consciousness, with a comparable Glasgow Coma Scale (GCS) index. The average operation time of the endoscopic group was longer than that of the non-endoscopic group (median 2.42 h vs 1.08 h, P < 0.001). Although the endoscopic group was older and had a baseline Graeb score that indicated more severe hemorrhage than the non-endoscopic group (Graeb median: Endoscopic group = 9 vs non-endoscopic group = 8, P = 0.023), the clearance rate of hematoma was as high as 60.5%. Both the endoscopic and non-endoscopic groups showed an improved GCS index after surgery. However, this improvement was more marked in patients in the endoscopic group (median improvement of GCS index: Endoscope group = 4 vs non-endoscopic group = 1, P < 0.001). Additionally, the endoscopic group had a lower Graeb score than the non-endoscopic group after the operation. The intensive care unit stay of the endoscopic group was significantly shorter than that of the non-endoscopic group (median: endoscopic group = 6 d vs non-endoscope group = 7 d, P = 0.017).
CONCLUSION Endoscopic evacuation of intraventricular hemorrhage was generally an effective and efficient way for hemorrhage evacuation, and contributed remarkably to the improvement of consciousness in patients with intraventricular hemorrhage.
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Affiliation(s)
- Feng-Bo Wang
- Department of Neurosurgery, Xinyi People's Hospital, Xinyi 221400, Jiangsu Province, China
| | - Xiao-Wa Yuan
- Department of Neurosurgery, Xinyi People's Hospital, Xinyi 221400, Jiangsu Province, China
| | - Jin-Xiao Li
- Department of Neurosurgery, Xinyi People's Hospital, Xinyi 221400, Jiangsu Province, China
| | - Ming Zhang
- Department of Neurosurgery, Xinyi People's Hospital, Xinyi 221400, Jiangsu Province, China
| | - Zhao-Hui Xiang
- Department of Neurosurgery, Xinyi People's Hospital, Xinyi 221400, Jiangsu Province, China
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Wang Z, Chen Y, Zhou X, Wang C, Chen X, Min F, Liu R, Xiang H. Risk Factor of Posthemorrhagic Hydrocephalus: Cerebrospinal Fluid Total Protein. Front Surg 2022; 9:692383. [PMID: 35252319 PMCID: PMC8891476 DOI: 10.3389/fsurg.2022.692383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 01/10/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Cerebrospinal fluid total protein (CSF-TP) levels in adults with posthemorrhagic hydrocephalus (PHH) are poorly studied. The objective of this study was to explore the characteristics of CSF-TP levels in patients with PHH. Methods The clinical data of 156 patients with hemorrhagic brain disease were retrospectively studied and divided into PHH and NPHH groups. Single-factor and multi-factor analyses were performed, and the key role of CSF-TP was evaluated using linear analysis. Results Among the 156 patients, 85 (54.5%) had PHH and 34 (21.8%) underwent surgeries. Hypertension (p = 0.017), days [total fever time when body temperature ≥ 38.5°C (p = 0.04)], Glasgow Coma Scale (GCS) score (p < 0.001), and time (from the onset of the disease to the obtainment of CSF-TP after lumbar puncture (p < 0.001) were important factors for PHH. Logistic regression analysis revealed that GCS score < 8 [odds ratio (OR) = 2.943 (1.421–6.097), p = 0.004] and CSF-TP × time ≥ 9,600 [OR = 2.317 (1.108–4.849), p = 0.026] were independent risk factors for PHH. All CSF-TP values were averaged every 2 days. CSF-TP was negatively correlated with time. Linear analysis showed that CSF-TP in the PHH group was higher than that in the NPHH group at the same onset time, and that the duration of detectionin the CSF was longer. Conclusion Cerebrospinal fluid total protein (CSF-TP) × time ≥ 9,600 and GCS score <8 were independent risk factors for PHH. CSF-TP was higher in the PHH group than in the NPHH group.
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Affiliation(s)
- Zhiwen Wang
- Department of Neurosurgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Yuxin Chen
- Department of Geriatric Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xinhui Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Changfeng Wang
- Department of Neurosurgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Xianjun Chen
- Department of Neurosurgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Feixiang Min
- Department of Neurosurgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
| | - Ruen Liu
- Department of Neurosurgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
- Department of Neurosurgery, Peking University People's Hospital, Beijing, China
- *Correspondence: Ruen Liu
| | - Hui Xiang
- Department of Neurosurgery, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
- Hui Xiang
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Yu S, Zhang N, Liu J, Li C, Qian S, Xu Y, Yang T, Li N, Zeng M, Li D, Xia C. Surgical revascularization vs. conservative treatment for adult hemorrhagic moyamoya disease: analysis of rebleeding in 322 consecutive patients. Neurosurg Rev 2021; 45:1709-1720. [PMID: 34859335 DOI: 10.1007/s10143-021-01689-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/06/2021] [Accepted: 11/04/2021] [Indexed: 11/30/2022]
Abstract
Whether surgical revascularization can prevent recurrent hemorrhage in hemorrhagic moyamoya disease (HMD) patients remains a matter of debate. This study mainly aims at the comparison of treatment effect between surgical revascularization and conservative treatment of adult HMD patients. We retrospectively enrolled 322 adult HMD patients, including 133 in revascularization group and 189 in conservative group. The revascularization group included patients who underwent combined (n = 97) or indirect revascularization alone (n = 36). Ninety-two and forty-one patients underwent unilateral and bilateral revascularization respectively. The modified Rankin scale (mRS) was used to assess the functional status. The comparison was made based on initial treatment paradigm among two categories: (1) revascularization vs. conservative, (2) unilateral vs. bilateral revascularization. The rebleeding rate was significantly lower in revascularization group than that in conservative group (14.3% vs. 27.0%, P = 0.007). As for the functional outcomes, the average mRS was significantly better in revascularization group (1.7 ± 1.5) than that in conservative group (2.8 ± 1.9) (P < 0.001). The death rate in revascularization group was 8.3% (11/133), comparing to 20.1% (38/189) in conservative group (P = 0.004). While comparing between unilateral and bilateral revascularization within the revascularization group, the result demonstrated lower annual rebleeding rate in bilateral group (0.5%/side-year) than that in unilateral group (3.3%/side-year) (P = 0.001). This study proved the better treatment efficacy of surgical revascularization than that of conservative treatment in HMD patients, regarding both in rebleeding rate and mortality rate. Furthermore, bilateral revascularization seems more effective in preventing rebleeding than unilateral revascularization.
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Affiliation(s)
- Shaojie Yu
- Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, 17 Lujiang Road, 230036, Hefei, Anhui, People's Republic of China.,Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Nan Zhang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Jian Liu
- Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, 17 Lujiang Road, 230036, Hefei, Anhui, People's Republic of China.,Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Changwen Li
- Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, 17 Lujiang Road, 230036, Hefei, Anhui, People's Republic of China.,Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Sheng Qian
- Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, 17 Lujiang Road, 230036, Hefei, Anhui, People's Republic of China.,Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Yong Xu
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Tao Yang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Nan Li
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Minghui Zeng
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Dongxue Li
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Chengyu Xia
- Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, 17 Lujiang Road, 230036, Hefei, Anhui, People's Republic of China. .,Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China.
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