The efficacy and applied value of endoscopic hematoma evacuation vs. external ventricular drainage (EVD) in the treatment of severe ventficular hemorrhage (IVH) were explored and compared.From Jan.2015 to Dec.2016,the...The efficacy and applied value of endoscopic hematoma evacuation vs. external ventricular drainage (EVD) in the treatment of severe ventficular hemorrhage (IVH) were explored and compared.From Jan.2015 to Dec.2016,the clinical data of 42 cases of IVH were retrospectively analyzed,including 18 patients undergoing endoscopic hematoma evacuation (group A),and 24patients receiving EVD (group B).The hematoma clearance rate was calculated by 3D Slicer software,and complications and outcomes were compared between the two groups.There were no significant differences in age,sex and Graeb score between groups A and B (P>0.05).The hematoma clearance rate was 70.81%±27.64% in group A and 48.72%±36.58% in group B with a statistically significant difference (P<0.05).The operative time in groups A and B was 72.45±25.26 min and 28.54±15.27min,respectively (P<0.05).The Glasgow Coma Scale (GCS) score increased from 9.28±2.72 at baseline to 11.83±2.91 at 1 week postoperatively in group A,and from 8.25±2.62 at baseline to 10.79±4.12 at 1 week postoperatively in group B (P<0.05).The length of hospital stay was 12.67±5.97 days in group A and 17.33±8.91 days in group B with a statistically significant difference (P<0.05).The GOS scores at 6 months after surgery were 3.83±1.12 in group A,and 2.75±1.23 in group B (P<0.05). These results suggested that endoscopic hematoma evacuation has an advantage of a higher hematoma clearance rate,fewer complications and better outcomes in the treatment of severe IVH,indicating it is a safe,effective and promising approach for severe IVH.展开更多
The external ventricular derivation is an invasive technique used to cure hydrocephalus.Sometimes,it may have infectiousand mechanical complications and needs specific cares.Very rarely, the drain line can be cut with...The external ventricular derivation is an invasive technique used to cure hydrocephalus.Sometimes,it may have infectiousand mechanical complications and needs specific cares.Very rarely, the drain line can be cut with an intraventricular section tip as in thecase reported.展开更多
In this study, we aimed to evaluate patients who develop ventriculostomy requirements and to evaluate the external ventricular drainage infection rates retrospectively at our clinic. In the study, dates between Januar...In this study, we aimed to evaluate patients who develop ventriculostomy requirements and to evaluate the external ventricular drainage infection rates retrospectively at our clinic. In the study, dates between January 2012 and 2014, patients who were inserted external ventricular drainage with different indications were examined retrospectively. By using the medical record system, patients’ demographics (age, sex), diagnostic, ventriculostomy indications and ventriculostomy time had been reached. By accessing laboratory data, the patients’ cultures of cerebrospinal fluids biochemical tests were analyzed retrospectively. Within the period of the study, 20 in 117 patients with external ventricular drainage were not included the study because of shunt infection and shunt occlusion of extracted patients. During the treatment period 148 EVD were inserted to 97 patients. The number of male patients was 53;the number of female patients was 44. When the reason of the examined patients’ using external ventricular drainage was analyzed, 55% hemorrhagic cerebrovascular diseases, (subarachnoid hemorrhage, intraventricular hemorrhage, intracerebral hemorrhage, cerebellar hemorrhage, traumatic intracranial injury), 24.7% tumor induced use, 7.4% central nervous system infections (menengitis, apse), and 12.4% occlusive cerebrovascular diseases (hydrocephalus or brain edema that were developed after the infarct) were seen. During the course of our study, 23% of the surveyed 97 patients had leukocytosis. CFT culture of 12 patients found positive. In CFT cultures mostly coagulase-negative staphylococcus growth took place. Eventually, when we compare our infection proportions to the international literature, very large differences were not observed. Except for revisioned patients, no other criteria were found that increased the rate of infection. We think that a rigorous pre-operative preparation and a regular maintenance of external ventricular drainage may reduce the rate of infection.展开更多
Background: The treatment of cerebellar hemorrhage (CH) may be different surgery or conservative according to the hematoma volume, compression of vital structures or hydrocephalus existence. In the present study, the ...Background: The treatment of cerebellar hemorrhage (CH) may be different surgery or conservative according to the hematoma volume, compression of vital structures or hydrocephalus existence. In the present study, the authors investigated the risk factors, the indications and the situation of external ventricular drainage (EVD) on the treatment line. Methods: 63 pure cerebellar hemorrhage patients were enrolled in the study. 36 cases underwent surgery;the other 27 were received conservative treatment. 15 and 13 cases received EVD in both groups. Hospital stay and mortality rates were investigated. Results: 4 cases in the conservative group underwent surgery secondary to treatment failure. Both of the groups had equal rates of morbidity and mortality. On the other hand, the group that received surgical intervention had shorter median hospital stay. The EVD does not seem to be life-saving at first but it gives time for preparing for surgery. Conclusions: We found that CH was strongly associated with early hydrocephalus and mortality. The early diagnosis and surgical evacuation of the mass are mandatory and life-saving if hematoma is larger than 10 ml. The EVD may not being a life-saving instrument but majorly it may be a time earning device if acute hydrocephalus present.展开更多
Intraventricular hemorrhage(IVH)is a dangerous acute cerebrovascular disease.The 30-day mortality rate of patients with IVH is 5 times that of patients with cerebral hemorrhage.In recent years,more and more studies ha...Intraventricular hemorrhage(IVH)is a dangerous acute cerebrovascular disease.The 30-day mortality rate of patients with IVH is 5 times that of patients with cerebral hemorrhage.In recent years,more and more studies have shown that timely clearance of intraventricular hematoma is closely related to good prognosis.The advantages of surgical intervention in patient management are impressive.This article briefly reviews the positive advances in the surgical treatment of IVH such as external ventricular drainage(EVD)combined with intraventricular fibrinolysis(IVF)and continuous lumbar cistern drainage(LCD),as well as their safety and efficacy,especially the remarkable role of neuroendoscopy in the removal of intraventricular hematomas.展开更多
目的探索神经内镜辅助丘脑血肿清除术联合同侧脑室外引流术与丘脑血肿引流联合对侧脑室外引流术治疗丘脑出血破入脑室(thalamic hemorrhage rupture into the ventricle,THRIV)的临床效果。方法选择锦州医科大学附属第一医院2020年9月至...目的探索神经内镜辅助丘脑血肿清除术联合同侧脑室外引流术与丘脑血肿引流联合对侧脑室外引流术治疗丘脑出血破入脑室(thalamic hemorrhage rupture into the ventricle,THRIV)的临床效果。方法选择锦州医科大学附属第一医院2020年9月至2022年6月的丘脑出血破入脑室患者73例,依不同手术治疗方式分为观察组(38例,行神经内镜辅助丘脑血肿清除术联合同侧脑室外引流术治疗)与对照组(35例,行丘脑血肿引流联合对侧脑室外引流术治疗),比较两组患者术后第3天血肿清除率、手术时长及术中的出血量、住院时长及费用、术后并发症及脑水肿情况、术后1 w格拉斯哥昏迷量表(glasgow coma scale,GCS)评分及术后3个月格拉斯哥预后量表(glasgow prognosis scale,GOS)评分。结果两组患者术前的各项指标差异无统计学意义(P>0.05)。观察组手术时长、术中出血量、住院花费和术后第3天血肿清除率均大于对照组,但其住院时间较对照组短,均有统计学意义(P<0.05)。观察组术后脑积水、颅内感染、肺部感染几率较对照组低(P<0.05);两组患者在再出血、癫痫、术后死亡和消化道出血方面差异无统计学意义(P>0.05)。观察组患者术后第3天脑水肿CT评分(BECTS)明显较对照组高,但其术后1 w BECTS较对照组低,差异均存在统计学意义(P<0.05)。观察组患者术后1 w GCS及术后3个月GOS评分均大大超过对照组(P<0.05)。结论神经内镜辅助丘脑血肿清除术联合同侧脑室外引流术可提高患者的血肿清除率,缩减住院时间和术后脑水肿的持续时间。减少术后脑积水、颅内感染和肺部感染的发生率,改善患者的3个月预后。展开更多
基金This study was funded by the Science and Technology Commission of Wuhan City (No.WX16B02)and Natural Science Foundation of Hubei Province (No.2018CFB353).
文摘The efficacy and applied value of endoscopic hematoma evacuation vs. external ventricular drainage (EVD) in the treatment of severe ventficular hemorrhage (IVH) were explored and compared.From Jan.2015 to Dec.2016,the clinical data of 42 cases of IVH were retrospectively analyzed,including 18 patients undergoing endoscopic hematoma evacuation (group A),and 24patients receiving EVD (group B).The hematoma clearance rate was calculated by 3D Slicer software,and complications and outcomes were compared between the two groups.There were no significant differences in age,sex and Graeb score between groups A and B (P>0.05).The hematoma clearance rate was 70.81%±27.64% in group A and 48.72%±36.58% in group B with a statistically significant difference (P<0.05).The operative time in groups A and B was 72.45±25.26 min and 28.54±15.27min,respectively (P<0.05).The Glasgow Coma Scale (GCS) score increased from 9.28±2.72 at baseline to 11.83±2.91 at 1 week postoperatively in group A,and from 8.25±2.62 at baseline to 10.79±4.12 at 1 week postoperatively in group B (P<0.05).The length of hospital stay was 12.67±5.97 days in group A and 17.33±8.91 days in group B with a statistically significant difference (P<0.05).The GOS scores at 6 months after surgery were 3.83±1.12 in group A,and 2.75±1.23 in group B (P<0.05). These results suggested that endoscopic hematoma evacuation has an advantage of a higher hematoma clearance rate,fewer complications and better outcomes in the treatment of severe IVH,indicating it is a safe,effective and promising approach for severe IVH.
文摘The external ventricular derivation is an invasive technique used to cure hydrocephalus.Sometimes,it may have infectiousand mechanical complications and needs specific cares.Very rarely, the drain line can be cut with an intraventricular section tip as in thecase reported.
文摘In this study, we aimed to evaluate patients who develop ventriculostomy requirements and to evaluate the external ventricular drainage infection rates retrospectively at our clinic. In the study, dates between January 2012 and 2014, patients who were inserted external ventricular drainage with different indications were examined retrospectively. By using the medical record system, patients’ demographics (age, sex), diagnostic, ventriculostomy indications and ventriculostomy time had been reached. By accessing laboratory data, the patients’ cultures of cerebrospinal fluids biochemical tests were analyzed retrospectively. Within the period of the study, 20 in 117 patients with external ventricular drainage were not included the study because of shunt infection and shunt occlusion of extracted patients. During the treatment period 148 EVD were inserted to 97 patients. The number of male patients was 53;the number of female patients was 44. When the reason of the examined patients’ using external ventricular drainage was analyzed, 55% hemorrhagic cerebrovascular diseases, (subarachnoid hemorrhage, intraventricular hemorrhage, intracerebral hemorrhage, cerebellar hemorrhage, traumatic intracranial injury), 24.7% tumor induced use, 7.4% central nervous system infections (menengitis, apse), and 12.4% occlusive cerebrovascular diseases (hydrocephalus or brain edema that were developed after the infarct) were seen. During the course of our study, 23% of the surveyed 97 patients had leukocytosis. CFT culture of 12 patients found positive. In CFT cultures mostly coagulase-negative staphylococcus growth took place. Eventually, when we compare our infection proportions to the international literature, very large differences were not observed. Except for revisioned patients, no other criteria were found that increased the rate of infection. We think that a rigorous pre-operative preparation and a regular maintenance of external ventricular drainage may reduce the rate of infection.
文摘Background: The treatment of cerebellar hemorrhage (CH) may be different surgery or conservative according to the hematoma volume, compression of vital structures or hydrocephalus existence. In the present study, the authors investigated the risk factors, the indications and the situation of external ventricular drainage (EVD) on the treatment line. Methods: 63 pure cerebellar hemorrhage patients were enrolled in the study. 36 cases underwent surgery;the other 27 were received conservative treatment. 15 and 13 cases received EVD in both groups. Hospital stay and mortality rates were investigated. Results: 4 cases in the conservative group underwent surgery secondary to treatment failure. Both of the groups had equal rates of morbidity and mortality. On the other hand, the group that received surgical intervention had shorter median hospital stay. The EVD does not seem to be life-saving at first but it gives time for preparing for surgery. Conclusions: We found that CH was strongly associated with early hydrocephalus and mortality. The early diagnosis and surgical evacuation of the mass are mandatory and life-saving if hematoma is larger than 10 ml. The EVD may not being a life-saving instrument but majorly it may be a time earning device if acute hydrocephalus present.
文摘Intraventricular hemorrhage(IVH)is a dangerous acute cerebrovascular disease.The 30-day mortality rate of patients with IVH is 5 times that of patients with cerebral hemorrhage.In recent years,more and more studies have shown that timely clearance of intraventricular hematoma is closely related to good prognosis.The advantages of surgical intervention in patient management are impressive.This article briefly reviews the positive advances in the surgical treatment of IVH such as external ventricular drainage(EVD)combined with intraventricular fibrinolysis(IVF)and continuous lumbar cistern drainage(LCD),as well as their safety and efficacy,especially the remarkable role of neuroendoscopy in the removal of intraventricular hematomas.
文摘目的探索神经内镜辅助丘脑血肿清除术联合同侧脑室外引流术与丘脑血肿引流联合对侧脑室外引流术治疗丘脑出血破入脑室(thalamic hemorrhage rupture into the ventricle,THRIV)的临床效果。方法选择锦州医科大学附属第一医院2020年9月至2022年6月的丘脑出血破入脑室患者73例,依不同手术治疗方式分为观察组(38例,行神经内镜辅助丘脑血肿清除术联合同侧脑室外引流术治疗)与对照组(35例,行丘脑血肿引流联合对侧脑室外引流术治疗),比较两组患者术后第3天血肿清除率、手术时长及术中的出血量、住院时长及费用、术后并发症及脑水肿情况、术后1 w格拉斯哥昏迷量表(glasgow coma scale,GCS)评分及术后3个月格拉斯哥预后量表(glasgow prognosis scale,GOS)评分。结果两组患者术前的各项指标差异无统计学意义(P>0.05)。观察组手术时长、术中出血量、住院花费和术后第3天血肿清除率均大于对照组,但其住院时间较对照组短,均有统计学意义(P<0.05)。观察组术后脑积水、颅内感染、肺部感染几率较对照组低(P<0.05);两组患者在再出血、癫痫、术后死亡和消化道出血方面差异无统计学意义(P>0.05)。观察组患者术后第3天脑水肿CT评分(BECTS)明显较对照组高,但其术后1 w BECTS较对照组低,差异均存在统计学意义(P<0.05)。观察组患者术后1 w GCS及术后3个月GOS评分均大大超过对照组(P<0.05)。结论神经内镜辅助丘脑血肿清除术联合同侧脑室外引流术可提高患者的血肿清除率,缩减住院时间和术后脑水肿的持续时间。减少术后脑积水、颅内感染和肺部感染的发生率,改善患者的3个月预后。
