神经内窥镜治疗脑室内出血的临床应用

Clinical Application of Neuroendoscopic Management for Intraventricular Hemorrhage

目的 我们回顾总结了2年来使用神经内窥镜治疗严重脑室内出血的经验,从而来验证其应用的安全性、有效性。 方法 15名自发性脑室内出血(原发性和继发性)患者都使用了神经内窥镜治疗。手术前后进行CT扫描,分别用Graeb评分和VCR率进行比较,并在术后第6个月进行Glasgow结果评分。 结果 所有患者的脑室内积血都被有效清除,Graeb评分在术后减少67% ,而VCR率则下降2 7%。尽管在脑血管畸形存在的情况下这个手术也是安全的。在所有患者中术后都没有发生继发性颅内出血或者脑水肿,6个月后的死亡率是2 6.7%。66%的患者表现了良好的结果。 结论 在这一组严重脑室内出血病人中,神经内窥镜治疗不仅有效减少了脑室内积血的数量,降低了脑室的扩张,还显示了很好的安全性,与其他传统治疗相比。

Objective Our 2-year experiences in the neuroendoscopic management for severe intraventricular hemorrhage (IVH) were reviewed to evaluate its safety, efficiency, and efficacy. Methods Fifteen patients with spontaneous primary or secondary IVH underwent neuroendoscopy. CT scans obtained before and after surgery were compared for Graeb score and ventriculocranial ratio. Glasgow Outcome Scale was assessed at the end of 6 months. Results In all the 15 patients, the procedure resulted in a substantial removal of ventricular blood. Graeb score was reduced by 67%, and ventriculocranial ratio was reduced by 27% (P<0.002). The procedure was carried out safely even in the presence of a vascular malformation, and no rebleeding or delayed hydrocephalus was observed. Mortality at the end of 6 months was 26.7%. Favorable outcome was observed in 66% of cases. Conclusions Neuroendoscopic management of severe IVH in this cohort of patients is safe, efficiently reduces the amount of ventricular blood and ventricular dilatation, and effectively produces an improved outcome as compared with other conventional treatments.