Predictive values of parameters of intracranial pressure wave for postoperative global cerebral edema in patients with aneurysmal subarachnoid hemorrhage

Abstract

Objective To investigate the correlation between the parameters of intracranial pressure (ICP) wave and global cerebral edema for providing basis of early prediction and intervention for global cerebral edema after operation in patients with aneurysmal subarachnoid hemorrhage (aSAH). Methods A total of 80 patients with aSAH admitted to Department of Neurosurgery, the First Affiliated Hospital of Chongqing Medical University from May 2017 to December 2017 were retrospectively enrolled. The parameters of ICP wave and clinical data of 80 patients within 3 days after intracranial aneurysm clipping were collected and analyzed. The aSAH patients were divided into the global cerebral endema (GCE) group (n=13) and NO-GCE group (n=67)to compare the clinical data and parameters of ICP wave. The multivariate logistic regression analysis was used to determine the risk factors that might lead to GCE. According to receiver operating characteristic (ROC) curve, diagnostic threshold values for GCE were evaluated and sensitivity and specificity were calculated for optimal thresholds to investigate the predictive value of parameters of intracranial pressure wave for postoperative GCE. Results The difference of mFisher(modified Fisher) grading, mean ICP wave amplitude (MWA) and R-symbol of correlation between amplitude and pressure (RAP) were significant between NO-GCE group and GCE group (P value: 0.012, 0.005, 0.001, respectively). The result of multivariate logistic regression analysis showed that mFisher grading (OR=8.896, 95%CI: 1.678-47.165, P=0.010), RAP (OR=2.130, 95%CI: 1.155-3.931, P=0.016) were independent risk factors of postoperative GCE. The optimal threshold values of MWA and RAP were 3.853 and 0.480 respectively, which had high diagnostic value in prediction of GCE. The relevant sensitivity and specificity were 84.6% and 70.1% for MWA and 92.3% and 74.6% for RAP. Conclusions The mFisher grading, MWA and RAP might be related to postoperative GCE in patients with aSAH.The mFisher grading and RAP are independent risk factors of postoperative GCE in patients with aSAH. Monitoring of MWA and RAP could help identify the early occurrence of GCE. Key words: Intracranial aneurysm; Subarachnoid hemorrhage; Intracranial pressure; Global cerebral edema; Predictive value