Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Spontaneous Cerebellar Hemorrhage with the Fourth Ventricular Hemorrhage : Risk Factors Associated with Ventriculoperitoneal Shunt

  • Shin, Donguk (Department of Neurosurgery, Kyungpook National University) ;
  • Woo, Hyun-Jin (Department of Neurosurgery, Kyungpook National University) ;
  • Park, Jaechan (Department of Neurosurgery, Kyungpook National University)
  • Received : 2012.05.04
  • Accepted : 2012.10.10
  • Published : 2012.10.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : The purposes of this study are to investigate the factors that may be related to ventriculoperitoneal (VP) shunt in patients with cerebellar hematoma and the effect of severe fourth ventricular hemorrhage, causing obstructive hydrocephalus on subsequent VP shunt performance. Methods : This study included 31 patients with spontaneous cerebellar hematoma and concomitant fourth ventricular hemorrhage, who did not undergo a surgical evacuation of hematoma. We divided this population into two groups; the VP shunt group, and the non-VP shunt group. The demographic data, radiologic findings, and clinical factors were compared in each group. The location of the hematoma (whether occupying the cerebellar hemisphere or the vermis) and the degree of the fourth ventricular obstruction were graded respectively. The intraventricular hemorrhage (IVH) score was used to assess the IVH severity. Results : Ten out of 31 patients underwent VP shunt operations. The midline location of cerebellar hematoma, the grade of fourth ventricle obstruction, and IVH severity were significantly correlated with that of VP shunt operation (p=0.015, p=0.013, p=0.028). The significant variables into a logistic regression multivariate model resulted in statistical significance for the location of cerebellar hemorrhage [p=0.05; odds ratio (OR), 8.18; 95% confidence interval (CI), 1.00 to 67.0], the grade of fourth ventricle obstruction (p=0.044; OR, 19.26; 95% CI, 1.07 to 346.6). Conclusion : The location of the cerebellar hematoma on CT scans and the degree of fourth ventricle obstruction by IVH were useful signs for the selection of VP shunt operation in patients with spontaneous cerebellar hematoma and concomitant acute hydrocephalus.

Keywords

References

  1. Bota DP, Lefranc F, Vilallobos HR, Brimioulle S, Vincent JL : Ventriculostomy- related infections in critically ill patients : a 6-year experience. J Neurosurg 103 : 468-472, 2005 https://doi.org/10.3171/jns.2005.103.3.0468
  2. Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Krieger D, et al. : Guidelines for the management of spontaneous intracerebral hemorrhage in adults : 2007 update : a guideline from the American Heart Association/American Stroke Association Stroke Council, High Blood Pressure Research Council, and the Quality of Care and Outcomes in Research Interdisciplinary Working Group. Circulation 116 : e391- e413, 2007 https://doi.org/10.1161/CIRCULATIONAHA.107.183689
  3. Broderick JP, Adams HP Jr, Barsan W, Feinberg W, Feldmann E, Grotta J, et al. : Guidelines for the management of spontaneous intracerebral hemorrhage : a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 30 : 905-915, 1999 https://doi.org/10.1161/01.STR.30.4.905
  4. Hallevi H, Dar NS, Barreto AD, Morales MM, Martin-Schild S, Abraham AT, et al. : The IVH score : a novel tool for estimating intraventricular hemorrhage volume : clinical and research implications. Crit Care Med 37 : 969-974, e1, 2009 https://doi.org/10.1097/CCM.0b013e318198683a
  5. Heiskanen O : Treatment of spontaneous intracerebral and intracerebellar hemorrhages. Stroke 24 (12 Suppl) : I94-I95; discussion I107-I108, 1993
  6. Hwang BY, Bruce SS, Appelboom G, Piazza MA, Carpenter AM, Gigante PR, et al. : Evaluation of intraventricular hemorrhage assessment methods for predicting outcome following intracerebral hemorrhage. J Neurosurg 116 : 185-192, 2012 https://doi.org/10.3171/2011.9.JNS10850
  7. Kang DH, Park J, Park SH, Kim YS, Hwang SK, Hamm IS : Early ventriculoperitoneal shunt placement after severe aneurysmal subarachnoid hemorrhage : role of intraventricular hemorrhage and shunt function. Neurosurgery 66 : 904-908; discussion 908-909, 2010 https://doi.org/10.1227/01.NEU.0000368385.74625.96
  8. Kirollos RW, Tyagi AK, Ross SA, van Hille PT, Marks PV : Management of spontaneous cerebellar hematomas : a prospective treatment protocol. Neurosurgery 49 : 1378-1386; discussion 1386-1387, 2001 https://doi.org/10.1097/00006123-200112000-00015
  9. Koziarski A, Frankiewicz E : Medical and surgical treatment of intracerebellar haematomas. Acta Neurochir (Wien) 110 : 24-28, 1991 https://doi.org/10.1007/BF01402043
  10. Little AS, Zabramski JM, Peterson M, Goslar PW, Wait SD, Albuquerque FC, et al. : Ventriculoperitoneal shunting after aneurysmal subarachnoid hemorrhage : analysis of the indications, complications, andoutcome with a focus on patients with borderline ventriculomegaly. Neurosurgery 62 : 618-627; discussion 618-627, 2008 https://doi.org/10.1227/01.neu.0000317310.62073.b2
  11. Luciano M, Pattisapu JV, Wickremesekera A : Infantile posthemorrhagic hydrocephalus in Winn HR (ed) : Youmans Neurological Surgery. Philadelphia, PA : Saunders, 2004, pp3405-3417
  12. Lui TN, Fairholm DJ, Shu TF, Chang CN, Lee ST, Chen HR : Surgical treatment of spontaneous cerebellar hemorrhage. Surg Neurol 23 : 555- 558, 1985 https://doi.org/10.1016/0090-3019(85)90002-3
  13. Mayfrank L, Hütter BO, Kohorst Y, Kreitschmann-Andermahr I, Rohde V, Thron A, et al. : Influence of intraventricular hemorrhage on outcome after rupture of intracranial aneurysm. Neurosurg Rev 24 : 185-191, 2001 https://doi.org/10.1007/s101430100160
  14. Morgenstern LB, Hemphill JC 3rd, Anderson C, Becker K, Broderick JP, Connolly ES Jr, et al. : Guidelines for the management of spontaneous intracerebral hemorrhage : a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 41 : 2108-2129, 2010 https://doi.org/10.1161/STR.0b013e3181ec611b
  15. Naff NJ, Hanley DF, Keyl PM, Tuhrim S, Kraut M, Bederson J, et al. : Intraventricular thrombolysis speeds blood clot resolution : results of a pilot, prospective, randomized, double-blind, controlled trial. Neurosurgery 54 : 577-583; discussion 583-584, 2004 https://doi.org/10.1227/01.NEU.0000108422.10842.60
  16. Pang D, Sclabassi RJ, Horton JA : Lysis of intraventricular blood clot with urokinase in a canine model : part 3. Effects of intraventricular urokinase on clot lysis and posthemorrhagic hydrocephalus. Neurosurgery 19 : 553-572, 1986 https://doi.org/10.1227/00006123-198610000-00010
  17. Park YG, Woo HJ, Kim E, Park J : Accuracy and safety of bedside external ventricular drain placement at two different cranial sites : Kocher's point versus Forehead. J Korean Neurosurg Soc 50 : 317-321, 2011 https://doi.org/10.3340/jkns.2011.50.4.317
  18. Rammos S, Klopfenstein J, Augspurger L, Wang H, Wagenbach A, Poston J, et al. : Conversion of external ventricular drains to ventriculoperitoneal shunts after aneurysmal subarachnoid hemorrhage : effects of site and protein/red blood cell counts on shunt infection and malfunction. J Neurosurg 109 : 1001-1004, 2008 https://doi.org/10.3171/JNS.2008.109.12.1001
  19. Vale FL, Bradley EL, Fisher WS 3rd : The relationship of subarachnoid hemorrhage and the need for postoperative shunting. J Neurosurg 86 : 462-466, 1997 https://doi.org/10.3171/jns.1997.86.3.0462
  20. van Gijn J, Hijdra A, Wijdicks EF, Vermeulen M, van Crevel H : Acute hydrocephalus after aneurysmal subarachnoid hemorrhage. J Neurosurg 63 : 355-362, 1985 https://doi.org/10.3171/jns.1985.63.3.0355

Cited by

  1. Surgical Treatment Results In Gastroschisis Based On Preterm Delivery Within The 34th Week Of Gestation By Caesarean Section vol.87, pp.7, 2012, https://doi.org/10.1515/pjs-2015-0068
  2. Endoscopic surgery via a combined frontal and suboccipital approach for cerebellar hemorrhage vol.9, pp.1, 2012, https://doi.org/10.4103/sni.sni_346_17