Application Of Quantitative Electroencephalogram Assessment In Patients With Secondary Hydrocephalus

Objective:To explore the clinical value of quantitative EEG in preoperative evaluation and postoperative prediction of patients with secondary hydrocephalus.Methods:Record the patient's basic information such as GCS score,muscle strength,muscle tone,swallowing function,urination and defecation,eye reaction and past medical history at admission.Quantitative EEG monitoring was conducted one day before surgery and one week after surgery: EEG background pattern,relative alpha variability variation pattern,spectral entropy,sleep awakening cycle,EEG reactivity(pain stimulation,light stimulation,auditory stimulation).After three months of follow-up,the patients were evaluated by Salmons hydrocephalus curative effect standard.The Salmons hydrocephalus curative effect score was 1~3 divided into good prognosis group and-2~0 divided into poor prognosis group.Analyze and quantify the clinical value of electroencephalogram indicators for patients with secondary hydrocephalus preoperative evaluation and postoperative prediction.Results:1.Twenty patients completed the experiment.male: female =16:4,age 10-60 years old,GCS scores ranged from 3 to 8 points: 13 cases,9 to 12 points: 5 cases,12 to 14 points: 2 cases,and 3 to 8 points: 13 cases,9 to 12 points: 5 cases,12 to 14points: 2 cases.Muscle strength 1~2 points: 16 cases,3~4 points: 4 cases.Muscle tone 0 points: 7 cases,1~2 points: 6 cases,3~4 points: 7 cases.Urine function 1~2points: 19 cases,5 points: 1 case;Swallowing function 1~2 points: 15 cases,3~4points: 3 cases,5 points: 2 cases;Ocular reaction score 1~2:13 cases,3~4:5 cases,5:2 cases.2.According to the efficacy criteria for hydrocephalus shunt of Salmons,grade3:1 case,grade 2:3 cases,grade 1:9 cases,grade 0:2 cases,grade-1:4 cases,that is13 cases in the good prognosis group and 7 cases in the poor prognosis group.3.Preoperative eeg monitoring of 16 patients was a continuous background,among which 13 patients had good shunt effect.There were 2 cases with discontinuous background,1 case with continuous low voltage,and 1 case with explosion-inhibition state,Patients had poor shunt effect.Preoperative eeg background pattern was used to predict the shunt effect in patients with secondary hydrocephalus,with sensitivity of 1 and specificity of 0.571,positive predictive value of 0.813 and negative predictive value of 1.4.Preoperative eeg monitoring found that 10 patients had sleep wake cycles,among which 9 patients had good shunt effect,10 patients had no sleep wake cycle,and 6 patients had poor shunt effect.Preoperative sleep wake cycle parameters were used to predict the shunt effect in patients with secondary hydrocephalus,with a sensitivity of 0.692 and specificity of 0.857,and a positive prediction value of 0.90 and a negative prediction value of 0.60.5.Fourteen patients presented EEG reactivity(EEG reactivity,EEG-R)when given pain stimulation by preoperative quantitative EEG monitoring,of which 11 had good shunt effect,6 had no EEG-R,and 5 had poor shunt effect.Preoperative eeg response(pain stimulation)was used to predict the shunt effect in patients with secondary hydrocephalus,with the sensitivity of 0.917,specificity of 0.625,positive predictive value of 0.786 and negative predictive value of 0.833.Among the 11 patients with EEG-R during light source stimulation,10 had good shunt effect,9 had no EEG-R,and 6 had poor shunt effect.EEG reactivity(light source stimulation)predicted shunt effect in patients with secondary hydrocephalus,with sensitivity of0.769 and specificity of 0.857,positive predictive value of 0.909 and negative predictive value of 0.667.During auditory stimulation,9 patients had EEG-R,among which 8 patients had good shunt effect,11 patients had no EEG-R,and 6patients had poor shunt effect.Electroencephalographic reactivity(auditory stimulation)predicted the shunt effect in patients with secondary hydrocephalus,with sensitivity of 0.615 and specificity of 0.857,positive predictive value of 0.889 and negative predictive value of 0.545.6.Postoperative relative alpha variability variation pattern: 3 cases of ?model has good prognosis in patients with 1 case(33%),9 cases ? patterns in patients with good prognosis in 8 cases(89%),including 1 patients are markedly improved,2 cases of patients with moderate improvement,5 patients with mild improvement.Five poor prognosis in patients with ? mode symptoms(no change)for 4 cases(80%),3 cases of ? patterns in patients with poor prognosis(symptoms worsen)in 3 cases(100%).CONCLUSIONS:1.The preoperative eeg background pattern of the patient is continuous background,there is a sleep awakening cycle,EEG reactivity,and the patient's shunt effect is good,otherwise the preoperative eeg background pattern is discontinuous background,continuous low voltage,burst-suppression State,no sleep awakening cycle,lack of eeg reactivity,the patient's shunt effect is poor.2.Postoperative patients' relative alpha variation is better than before surgery,which may be related to the improvement of patients' cerebral blood flow after surgery.The patient's shunt effect is good,otherwise,the postoperative patients' relative alpha variation becomes worse,the patient's shunt effect is poor.Quantitative EEG is an effective method for preoperative evaluation and postoperative prediction of patients with secondary hydrocephalus.