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ORIGINAL RESEARCH article
Front. Surg.
Sec. Neurosurgery
Volume 11 - 2024 |
doi: 10.3389/fsurg.2024.1467154
This article is part of the Research Topic Functional Approach To Neurosurgery: Current Research and Future Perspectives View all 7 articles
Increased Brain Volume in the Early Phase of Aneurysmal Subarachnoid Hemorrhage leads to Delayed Cerebral Ischemia
Provisionally accepted
Chao Sun
1*
Bin Qin
2,3
Jingyu Zhang
3*
Yidan Liang
1,2
Cui Min
1
Qiang Yang
1
Yanglingxi Wang
1
Jian Gong
1*
Yi Xiang
1*- 1 Department of Neurosurgery, Chongqing University Central Hospital, Chongqing, China, Chongqing, China
- 2 First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- 3 Department of Neurosurgery, Daping Hospital, Chongqing, China
Objective: To investigate the correlation between the swelling rate of brain volume within the first 48 hours after aneurysmal subarachnoid hemorrhage and the subsequent development of delayed cerebral ischemia. Methods: A retrospective analysis was conducted on patients with spontaneous aneurysmal subarachnoid hemorrhage admitted to the Neurosurgery Intensive Care Unit of the First Affiliated Hospital of Chongqing Medical University between January 2020 and January 2023. The clinical data, treatment outcomes, and imaging data were analyzed. Brain volume was evaluated using 3D-Slicer software at two time points post-hemorrhage: within the first 24 hours and between 24 to 48 hours. The swelling rate of brain volume was defined as the ratio of the absolute difference between two measurements to the smaller of values. Patients were categorized into two groups based on established diagnostic criteria of delayed cerebral ischemia. Univariate and multivariate logistic regression analyses were performed to identify factors influencing delayed cerebral ischemia. Results: A total of 140 patients were enrolled in this study. 46 patients experienced delayed cerebral ischemia after bleeding. The swelling rate of brain volume was larger in the DCI group (10.66 ± 8.45) compared to the non-DCI group (3.59 ± 2.62), which showed a statistically significant difference. Additionally, advanced age, smoking history, history of hypertension, loss of consciousness, poor Hunt-Hess grade, high mFisher score, brain volume within 24h, and IVH were also statistically different between the two groups. Multivariate logistic regression analysis revealed that the swelling rate of brain volume, high mFisher score, and smoking history are independent risk factors for DCI with adjusting the advanced age, history of hypertension, loss of consciousness, poor Hunt-Hess grade, brain volume within 24h, and IVH. Conclusion: Brain volume significantly increased in patients with aneurysmal subarachnoid hemorrhage during the early phase (within 48 hours post-onset). The larger swelling rate of brain volume is an independent risk factor for the development of delayed cerebral ischemia, and it may hold significant predictive value for the incidence of delayed cerebral ischemia.
Keywords: Aneurysmal subarachnoid hemorrhage (aSAH), Early brain injury (EBI), 3D-Slicer, swelling rate of brain volume, Delayed cerebral ischemia (DCI)
Received: 19 Jul 2024; Accepted: 05 Sep 2024.
Copyright: © 2024 Sun, Qin, Zhang, Liang, Min, Yang, Wang, Gong and Xiang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Chao Sun, Department of Neurosurgery, Chongqing University Central Hospital, Chongqing, China, Chongqing, China
Jingyu Zhang, Department of Neurosurgery, Daping Hospital, Chongqing, China
Jian Gong, Department of Neurosurgery, Chongqing University Central Hospital, Chongqing, China, Chongqing, China
Yi Xiang, Department of Neurosurgery, Chongqing University Central Hospital, Chongqing, China, Chongqing, China
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