早期终板造瘘治疗动脉瘤性蛛网膜下腔出血后急性脑积水的疗效

The efficacy of early lamina terminalis fenestration in treating acute hydrocephalus after aneurismal subarachnoid hemorrhage

目的 探究早期终板造瘘治疗动脉瘤性蛛网膜下腔出血（aSAH）后急性脑积水的疗效.方法 回顾性分析98例aSAH后急性脑积水并早期行开颅动脉瘤夹闭术患者的临床资料,按术中是否同时施行终板造瘘分为夹闭造瘘组（56例）和单纯夹闭组（42例）.比较两组急性脑积水的好转率及术后需要行脑室-腹腔分流术的比率,并比较责任动脉瘤的部位对急性脑积水好转率及术后行分流手术比率的影响.结果 98例患者术后急性脑积水好转率为46.9％（46例）,行分流手术的比率为27.6％（27例）.其中夹闭造瘘组好转率为57.1％（32例）,术后行分流手术的比率为23.2％（13例）;单纯夹闭组脑积水好转率及术后行分流手术的比率均为33.3％（14例）.两组急性脑积水的好转率差异有统计学意义（P＜0.05）,术后行分流手术的比率差异无统计学意义.夹闭造瘘组与单纯夹闭组中的后循环动脉瘤患者比较,急性脑积水的好转率（76.0％对比25.0％）及术后行分流手术的比率（8.0％对比50.0％）差异均有统计学意义（均P＜0.05）;两组前循环动脉瘤患者比较,脑积水的好转率及术后行分流手术比率的差异均无统计学意义（P＞0.05）.结论 早期终板造瘘对aSAH后急性脑积水的疗效较好,尤其是对后循环动脉瘤患者的疗效更好.

Objective To explore the efficacy of early lamina terminalis fenestration in the treatment of acute hydrocephalus after aneurismal subarachnoid hemorrhage.Methods Ninety-eight patients of acute hydrocephalus after aneurismal subarachnoid hemorrhage who were treated by clipping were retrospectively analyzed.These cases were divided into two groups,including aneurysm clipping group alone （42 cases） and clipping with lamina terminalis fenestration group（56 cases）.The improving rate of acute hydrocephalus and the incidence rate of shunt-dependent hydrocephalus after surgical treatment were compared between two groups.Results All surgical clipping procedures were performed within 72 hours after aneurysm rupture.Ultimately,46 cases of acute hydrocephalus patients acquired improvement and 27 cases developed to chronic hydrocephalus after surgical treatment among 98 patients.Fourteen cases of acute hydrocephalus patients in aneurysm clipping group were improved （the improvement rate was 33.3%） and 14 cases developed into shunt-dependent hydrocephalus （the incidence rate was 33.3%）.Thirty-two cases of acute hydrocephalus patients in lamina terminalis fenestration after aneurysm clipping group were improved （the improvement rate was 57.1%） and 13 cases developed into chronic hydrocephalus （the incidence rate was 23.2%）.The acute hydrocephalus improvement rate and shunt-dependent hydrocephalus incidence rate in posterior circulation aneurysm group were statistically difference between aneurysm clipping group and lamina terminalis fenestration after aneurysm clipping group （P 〈 0.05）,but not in anterior circulation aneurysm group （P 〉 0.05）.Conclusions The efficacy of early lamina terminalis fenestration in the treatment of acute hydrocephalus after aneurismal subarachnoid hemorrhage was effective in posteriorcirculation aneurysm clipping.