术中脑室外引流对Ⅳ~Ⅴ级破裂颅内动脉瘤的作用

The role of intraoperative ventricular drainage for grade Ⅳ~Ⅴ ruptured intracranial aneurysms

目的评价术中脑室外引流在Ⅳ~Ⅴ级破裂颅内动脉瘤手术中的作用。方法回顾性分析2010年6月至2019年12月滨州医学院烟台附属医院神经外科收治的63例Hunt-Hess分级Ⅳ~Ⅴ级破裂颅内动脉瘤患者的临床资料。63例患者均行急性期开颅动脉瘤夹闭术,夹闭前行同侧脑室穿刺引流。术后根据格拉斯哥预后分级(GOS)评价患者预后情况。结果63例患者中62例行动脉瘤夹闭术,其中1例因严重动脉粥样硬化仅行动脉瘤外壁加强术,术中颅内压平均下降177.15 mmH_(2)O,术中脑脊液平均释放27.85 ml。术后随访6个月,脑积水发生率为9.52%(6/63),脑梗死发生率为30.2%(19/63)。根据GOS评分评价,恢复良好30例,中度残疾8例,重度残疾13例,死亡12例。结论在Hunt-Hess分级Ⅳ~Ⅴ级破裂颅内动脉瘤急性期手术中应用脑室引流术,可有效降低颅内压,有利于解剖分离侧裂,显露并夹闭动脉瘤,同时可减轻对脑组织损伤,减少脑血管痉挛及术后脑积水的诱发因素。

ObjectiveTo evaluate the role of intraoperative ventricular drainage inⅣ~Ⅴgrade ruptured intracranial aneurysm.MethodsThe clinical data of 63 cases with Hunt-Hess gradeⅣ~Ⅴruptured intracranial aneurysms were collected retrospectively in the department of Neurosurgery in Yantai Affiliated Hospital of Binzhou Medical University between June 2010 and February 2019.All 63 cases underwent craniotomy aneurysm surgery,preoperative surgical clipping of the aneurysm,and the Paine-point line with the lateral ventricle puncture.Postoperative prognosis of all patients was evaluated according to Glasgow Outcome Rating Scale(GOS).ResultsAmong all patients,62 underwent routine aneurysm surgery,and the other one who was with severe atherosclerosis underwent the outer wall of the aneurysm strengthen surgery.Intracranial pressure dropped by an average of 177.15 mmH_(2)O during the operation and an average of 27.85 ml of cerebrospinal fluid was released after the operation.After 6 months of follow-up,the incidence of hydrocephalus was 9.52%(6/63)and the incidence of cerebral infarction was 30.2%(19/63).According to GOS and after a followed up of 6 months,30 cases presented with good recovery,8 with moderate disability,13 with severe disability,and 12 ended with deaths.ConclusionIn Hunt-Hess gradeⅣ~Ⅴruptured intracranial aneurysm surgery,ventricular drainage can effectively reduce intracranial pressure in favor of dissecting sylvian to reveal aneurysm and conducive aneurysm,and mitigate brain damage,cerebral vasospasm and hydrocephalus.