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The value of ventricular measurements in the prediction of shunt dependency after aneurysmal subarachnoid hemorrhage
Objective Chronic hydrocephalus requiring shunt placement is a common complication of aneurysmal subarachnoid hemorrhage (SAH). Different risk factors and prediction scores for post-SAH shunt dependency have been evaluated so far. We analyzed the value of ventricle measurements for prediction of the...
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| Published in: | Acta neurochirurgica 2023-06, Vol.165 (6), p.1545-1555 |
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| container_issue | 6 |
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| container_title | Acta neurochirurgica |
| container_volume | 165 |
| creator | Said, Maryam Gümüs, Meltem Rodemerk, Jan Chihi, Mehdi Rauschenbach, Laurèl Dinger, Thiemo F. Darkwah Oppong, Marvin Dammann, Philipp Wrede, Karsten H. Sure, Ulrich Jabbarli, Ramazan |
| description | Objective
Chronic hydrocephalus requiring shunt placement is a common complication of aneurysmal subarachnoid hemorrhage (SAH). Different risk factors and prediction scores for post-SAH shunt dependency have been evaluated so far. We analyzed the value of ventricle measurements for prediction of the need for shunt placement in SAH patients.
Methods
Eligible SAH cases treated between 01/2003 and 06/2016 were included. Initial computed tomography scans were reviewed to measure ventricle indices (bifrontal, bicaudate, Evans’, ventricular, Huckman’s, and third ventricle ratio). Previously introduced CHESS and SDASH scores for shunt dependency were calculated. Receiver operating characteristic analyses were performed for diagnostic accuracy of the ventricle indices and to identify the clinically relevant cut-offs.
Results
Shunt placement followed in 221 (36.5%) of 606 patients. In univariate analyses, all ventricular indices were associated with shunting (all:
p |
| doi_str_mv | 10.1007/s00701-023-05595-6 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10227125</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2808585912</sourcerecordid><originalsourceid>FETCH-LOGICAL-c475t-a6bc72df2af26a1963b7288f58b71dec658e371e5b32bdeaca1829355cbac3383</originalsourceid><addsrcrecordid>eNp9kU1v1DAQhi1URD_gD3BAlnrhkuKPdeKcUFVBW6kSl3K2Js5k4yqxFzteaf89XrYtpQcu45HnmfG8fgn5yNkFZ6z5kkpgvGJCVkypVlX1G3LC2pWoSmBHL_JjcprSA2NcNCv5jhzLpmRN256Q5X5EuoUpIw0D3aJforN5gkhnhJQjzuUqUefpUsBNxN7ZxQW_p9OY_UJ73KDv0dsdhWHBSMFjjrs0w0RT7iCCHX1wPR1xDjGOsMb35O0AU8IPj-cZ-fn92_3VTXX34_r26vKusqtGLRXUnW1EPwgYRA28rWXXCK0HpbuG92hrpbEoQdVJ0fUIFrgWrVTKdmCl1PKMfD3M3eRuxt7u1cFkNtHNEHcmgDP_VrwbzTpsDWdClC9SZcLnxwkx_MqYFjO7ZHGaisiQkxGaaaVVy0VBz1-hDyFHX_QVSrCy_kruKXGgbAwpRRyet-HM7F01B1dNcdX8cdXUpenTSx3PLU82FkAegFRKfo3x79v_GfsbL02w1g</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2820196432</pqid></control><display><type>article</type><title>The value of ventricular measurements in the prediction of shunt dependency after aneurysmal subarachnoid hemorrhage</title><source>Springer Link</source><creator>Said, Maryam ; Gümüs, Meltem ; Rodemerk, Jan ; Chihi, Mehdi ; Rauschenbach, Laurèl ; Dinger, Thiemo F. ; Darkwah Oppong, Marvin ; Dammann, Philipp ; Wrede, Karsten H. ; Sure, Ulrich ; Jabbarli, Ramazan</creator><creatorcontrib>Said, Maryam ; Gümüs, Meltem ; Rodemerk, Jan ; Chihi, Mehdi ; Rauschenbach, Laurèl ; Dinger, Thiemo F. ; Darkwah Oppong, Marvin ; Dammann, Philipp ; Wrede, Karsten H. ; Sure, Ulrich ; Jabbarli, Ramazan</creatorcontrib><description>Objective
Chronic hydrocephalus requiring shunt placement is a common complication of aneurysmal subarachnoid hemorrhage (SAH). Different risk factors and prediction scores for post-SAH shunt dependency have been evaluated so far. We analyzed the value of ventricle measurements for prediction of the need for shunt placement in SAH patients.
Methods
Eligible SAH cases treated between 01/2003 and 06/2016 were included. Initial computed tomography scans were reviewed to measure ventricle indices (bifrontal, bicaudate, Evans’, ventricular, Huckman’s, and third ventricle ratio). Previously introduced CHESS and SDASH scores for shunt dependency were calculated. Receiver operating characteristic analyses were performed for diagnostic accuracy of the ventricle indices and to identify the clinically relevant cut-offs.
Results
Shunt placement followed in 221 (36.5%) of 606 patients. In univariate analyses, all ventricular indices were associated with shunting (all:
p
<0.0001). The area under the curve (AUC) ranged between 0.622 and 0.662. In multivariate analyses, only Huckman’s index was associated with shunt dependency (cut-off at ≥6.0cm,
p
<0.0001) independent of the CHESS score as baseline prediction model. A combined score (0–10 points) containing the CHESS score components (0–8 points) and Huckman’s index (+2 points) showed better diagnostic accuracy (AUC=0.751) than the CHESS (AUC=0.713) and SDASH (AUC=0.693) scores and the highest overall model quality (0.71 vs. 0.65 and 0.67), respectively.
Conclusions
Ventricle measurements are feasible for early prediction of shunt placement after SAH. The combined prediction model containing the CHESS score and Huckman’s index showed remarkable diagnostic accuracy regarding identification of SAH individuals requiring shunt placement. External validation of the presented combined CHESS-Huckman score is mandatory.</description><identifier>ISSN: 0942-0940</identifier><identifier>ISSN: 0001-6268</identifier><identifier>EISSN: 0942-0940</identifier><identifier>DOI: 10.1007/s00701-023-05595-6</identifier><identifier>PMID: 37127799</identifier><language>eng</language><publisher>Vienna: Springer Vienna</publisher><subject>Accuracy ; Aneurysm ; Cerebral Ventricles - diagnostic imaging ; Cerebral Ventricles - surgery ; Cerebrospinal Fluid Shunts - adverse effects ; Computed tomography ; Humans ; Hydrocephalus ; Interventional Radiology ; Medicine ; Medicine & Public Health ; Minimally Invasive Surgery ; Neurology ; Neuroradiology ; Neurosurgery ; Original ; Original Article ; Prediction models ; Retrospective Studies ; Risk factors ; Shunts ; Subarachnoid hemorrhage ; Subarachnoid Hemorrhage - complications ; Subarachnoid Hemorrhage - diagnostic imaging ; Subarachnoid Hemorrhage - surgery ; Surgical Orthopedics ; Third Ventricle - surgery ; Vascular Neurosurgery – Aneurysm ; Ventricle ; Ventricles (cerebral)</subject><ispartof>Acta neurochirurgica, 2023-06, Vol.165 (6), p.1545-1555</ispartof><rights>The Author(s) 2023</rights><rights>2023. The Author(s).</rights><rights>The Author(s) 2023. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c475t-a6bc72df2af26a1963b7288f58b71dec658e371e5b32bdeaca1829355cbac3383</citedby><cites>FETCH-LOGICAL-c475t-a6bc72df2af26a1963b7288f58b71dec658e371e5b32bdeaca1829355cbac3383</cites><orcidid>0000-0002-6614-669X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37127799$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Said, Maryam</creatorcontrib><creatorcontrib>Gümüs, Meltem</creatorcontrib><creatorcontrib>Rodemerk, Jan</creatorcontrib><creatorcontrib>Chihi, Mehdi</creatorcontrib><creatorcontrib>Rauschenbach, Laurèl</creatorcontrib><creatorcontrib>Dinger, Thiemo F.</creatorcontrib><creatorcontrib>Darkwah Oppong, Marvin</creatorcontrib><creatorcontrib>Dammann, Philipp</creatorcontrib><creatorcontrib>Wrede, Karsten H.</creatorcontrib><creatorcontrib>Sure, Ulrich</creatorcontrib><creatorcontrib>Jabbarli, Ramazan</creatorcontrib><title>The value of ventricular measurements in the prediction of shunt dependency after aneurysmal subarachnoid hemorrhage</title><title>Acta neurochirurgica</title><addtitle>Acta Neurochir</addtitle><addtitle>Acta Neurochir (Wien)</addtitle><description>Objective
Chronic hydrocephalus requiring shunt placement is a common complication of aneurysmal subarachnoid hemorrhage (SAH). Different risk factors and prediction scores for post-SAH shunt dependency have been evaluated so far. We analyzed the value of ventricle measurements for prediction of the need for shunt placement in SAH patients.
Methods
Eligible SAH cases treated between 01/2003 and 06/2016 were included. Initial computed tomography scans were reviewed to measure ventricle indices (bifrontal, bicaudate, Evans’, ventricular, Huckman’s, and third ventricle ratio). Previously introduced CHESS and SDASH scores for shunt dependency were calculated. Receiver operating characteristic analyses were performed for diagnostic accuracy of the ventricle indices and to identify the clinically relevant cut-offs.
Results
Shunt placement followed in 221 (36.5%) of 606 patients. In univariate analyses, all ventricular indices were associated with shunting (all:
p
<0.0001). The area under the curve (AUC) ranged between 0.622 and 0.662. In multivariate analyses, only Huckman’s index was associated with shunt dependency (cut-off at ≥6.0cm,
p
<0.0001) independent of the CHESS score as baseline prediction model. A combined score (0–10 points) containing the CHESS score components (0–8 points) and Huckman’s index (+2 points) showed better diagnostic accuracy (AUC=0.751) than the CHESS (AUC=0.713) and SDASH (AUC=0.693) scores and the highest overall model quality (0.71 vs. 0.65 and 0.67), respectively.
Conclusions
Ventricle measurements are feasible for early prediction of shunt placement after SAH. The combined prediction model containing the CHESS score and Huckman’s index showed remarkable diagnostic accuracy regarding identification of SAH individuals requiring shunt placement. External validation of the presented combined CHESS-Huckman score is mandatory.</description><subject>Accuracy</subject><subject>Aneurysm</subject><subject>Cerebral Ventricles - diagnostic imaging</subject><subject>Cerebral Ventricles - surgery</subject><subject>Cerebrospinal Fluid Shunts - adverse effects</subject><subject>Computed tomography</subject><subject>Humans</subject><subject>Hydrocephalus</subject><subject>Interventional Radiology</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Minimally Invasive Surgery</subject><subject>Neurology</subject><subject>Neuroradiology</subject><subject>Neurosurgery</subject><subject>Original</subject><subject>Original Article</subject><subject>Prediction models</subject><subject>Retrospective Studies</subject><subject>Risk factors</subject><subject>Shunts</subject><subject>Subarachnoid hemorrhage</subject><subject>Subarachnoid Hemorrhage - complications</subject><subject>Subarachnoid Hemorrhage - diagnostic imaging</subject><subject>Subarachnoid Hemorrhage - surgery</subject><subject>Surgical Orthopedics</subject><subject>Third Ventricle - surgery</subject><subject>Vascular Neurosurgery – Aneurysm</subject><subject>Ventricle</subject><subject>Ventricles (cerebral)</subject><issn>0942-0940</issn><issn>0001-6268</issn><issn>0942-0940</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9kU1v1DAQhi1URD_gD3BAlnrhkuKPdeKcUFVBW6kSl3K2Js5k4yqxFzteaf89XrYtpQcu45HnmfG8fgn5yNkFZ6z5kkpgvGJCVkypVlX1G3LC2pWoSmBHL_JjcprSA2NcNCv5jhzLpmRN256Q5X5EuoUpIw0D3aJforN5gkhnhJQjzuUqUefpUsBNxN7ZxQW_p9OY_UJ73KDv0dsdhWHBSMFjjrs0w0RT7iCCHX1wPR1xDjGOsMb35O0AU8IPj-cZ-fn92_3VTXX34_r26vKusqtGLRXUnW1EPwgYRA28rWXXCK0HpbuG92hrpbEoQdVJ0fUIFrgWrVTKdmCl1PKMfD3M3eRuxt7u1cFkNtHNEHcmgDP_VrwbzTpsDWdClC9SZcLnxwkx_MqYFjO7ZHGaisiQkxGaaaVVy0VBz1-hDyFHX_QVSrCy_kruKXGgbAwpRRyet-HM7F01B1dNcdX8cdXUpenTSx3PLU82FkAegFRKfo3x79v_GfsbL02w1g</recordid><startdate>20230601</startdate><enddate>20230601</enddate><creator>Said, Maryam</creator><creator>Gümüs, Meltem</creator><creator>Rodemerk, Jan</creator><creator>Chihi, Mehdi</creator><creator>Rauschenbach, Laurèl</creator><creator>Dinger, Thiemo F.</creator><creator>Darkwah Oppong, Marvin</creator><creator>Dammann, Philipp</creator><creator>Wrede, Karsten H.</creator><creator>Sure, Ulrich</creator><creator>Jabbarli, Ramazan</creator><general>Springer Vienna</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-6614-669X</orcidid></search><sort><creationdate>20230601</creationdate><title>The value of ventricular measurements in the prediction of shunt dependency after aneurysmal subarachnoid hemorrhage</title><author>Said, Maryam ; Gümüs, Meltem ; Rodemerk, Jan ; Chihi, Mehdi ; Rauschenbach, Laurèl ; Dinger, Thiemo F. ; Darkwah Oppong, Marvin ; Dammann, Philipp ; Wrede, Karsten H. ; Sure, Ulrich ; Jabbarli, Ramazan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c475t-a6bc72df2af26a1963b7288f58b71dec658e371e5b32bdeaca1829355cbac3383</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Accuracy</topic><topic>Aneurysm</topic><topic>Cerebral Ventricles - diagnostic imaging</topic><topic>Cerebral Ventricles - surgery</topic><topic>Cerebrospinal Fluid Shunts - adverse effects</topic><topic>Computed tomography</topic><topic>Humans</topic><topic>Hydrocephalus</topic><topic>Interventional Radiology</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Minimally Invasive Surgery</topic><topic>Neurology</topic><topic>Neuroradiology</topic><topic>Neurosurgery</topic><topic>Original</topic><topic>Original Article</topic><topic>Prediction models</topic><topic>Retrospective Studies</topic><topic>Risk factors</topic><topic>Shunts</topic><topic>Subarachnoid hemorrhage</topic><topic>Subarachnoid Hemorrhage - complications</topic><topic>Subarachnoid Hemorrhage - diagnostic imaging</topic><topic>Subarachnoid Hemorrhage - surgery</topic><topic>Surgical Orthopedics</topic><topic>Third Ventricle - surgery</topic><topic>Vascular Neurosurgery – Aneurysm</topic><topic>Ventricle</topic><topic>Ventricles (cerebral)</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Said, Maryam</creatorcontrib><creatorcontrib>Gümüs, Meltem</creatorcontrib><creatorcontrib>Rodemerk, Jan</creatorcontrib><creatorcontrib>Chihi, Mehdi</creatorcontrib><creatorcontrib>Rauschenbach, Laurèl</creatorcontrib><creatorcontrib>Dinger, Thiemo F.</creatorcontrib><creatorcontrib>Darkwah Oppong, Marvin</creatorcontrib><creatorcontrib>Dammann, Philipp</creatorcontrib><creatorcontrib>Wrede, Karsten H.</creatorcontrib><creatorcontrib>Sure, Ulrich</creatorcontrib><creatorcontrib>Jabbarli, Ramazan</creatorcontrib><collection>SpringerOpen</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Acta neurochirurgica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Said, Maryam</au><au>Gümüs, Meltem</au><au>Rodemerk, Jan</au><au>Chihi, Mehdi</au><au>Rauschenbach, Laurèl</au><au>Dinger, Thiemo F.</au><au>Darkwah Oppong, Marvin</au><au>Dammann, Philipp</au><au>Wrede, Karsten H.</au><au>Sure, Ulrich</au><au>Jabbarli, Ramazan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The value of ventricular measurements in the prediction of shunt dependency after aneurysmal subarachnoid hemorrhage</atitle><jtitle>Acta neurochirurgica</jtitle><stitle>Acta Neurochir</stitle><addtitle>Acta Neurochir (Wien)</addtitle><date>2023-06-01</date><risdate>2023</risdate><volume>165</volume><issue>6</issue><spage>1545</spage><epage>1555</epage><pages>1545-1555</pages><issn>0942-0940</issn><issn>0001-6268</issn><eissn>0942-0940</eissn><abstract>Objective
Chronic hydrocephalus requiring shunt placement is a common complication of aneurysmal subarachnoid hemorrhage (SAH). Different risk factors and prediction scores for post-SAH shunt dependency have been evaluated so far. We analyzed the value of ventricle measurements for prediction of the need for shunt placement in SAH patients.
Methods
Eligible SAH cases treated between 01/2003 and 06/2016 were included. Initial computed tomography scans were reviewed to measure ventricle indices (bifrontal, bicaudate, Evans’, ventricular, Huckman’s, and third ventricle ratio). Previously introduced CHESS and SDASH scores for shunt dependency were calculated. Receiver operating characteristic analyses were performed for diagnostic accuracy of the ventricle indices and to identify the clinically relevant cut-offs.
Results
Shunt placement followed in 221 (36.5%) of 606 patients. In univariate analyses, all ventricular indices were associated with shunting (all:
p
<0.0001). The area under the curve (AUC) ranged between 0.622 and 0.662. In multivariate analyses, only Huckman’s index was associated with shunt dependency (cut-off at ≥6.0cm,
p
<0.0001) independent of the CHESS score as baseline prediction model. A combined score (0–10 points) containing the CHESS score components (0–8 points) and Huckman’s index (+2 points) showed better diagnostic accuracy (AUC=0.751) than the CHESS (AUC=0.713) and SDASH (AUC=0.693) scores and the highest overall model quality (0.71 vs. 0.65 and 0.67), respectively.
Conclusions
Ventricle measurements are feasible for early prediction of shunt placement after SAH. The combined prediction model containing the CHESS score and Huckman’s index showed remarkable diagnostic accuracy regarding identification of SAH individuals requiring shunt placement. External validation of the presented combined CHESS-Huckman score is mandatory.</abstract><cop>Vienna</cop><pub>Springer Vienna</pub><pmid>37127799</pmid><doi>10.1007/s00701-023-05595-6</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-6614-669X</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Accuracy Aneurysm Cerebral Ventricles - diagnostic imaging Cerebral Ventricles - surgery Cerebrospinal Fluid Shunts - adverse effects Computed tomography Humans Hydrocephalus Interventional Radiology Medicine Medicine & Public Health Minimally Invasive Surgery Neurology Neuroradiology Neurosurgery Original Original Article Prediction models Retrospective Studies Risk factors Shunts Subarachnoid hemorrhage Subarachnoid Hemorrhage - complications Subarachnoid Hemorrhage - diagnostic imaging Subarachnoid Hemorrhage - surgery Surgical Orthopedics Third Ventricle - surgery Vascular Neurosurgery – Aneurysm Ventricle Ventricles (cerebral) |
| title | The value of ventricular measurements in the prediction of shunt dependency after aneurysmal subarachnoid hemorrhage |
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