Analysis of combined coiling and neuroendoscopy in the treatment of intraventricular hemorrhage due to ruptured aneurysm.
Analysis of combined coiling and neuroendoscopy in the treatment of intraventricular hemorrhage due to ruptured aneurysm.
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弹簧圈弹簧圈与神经内镜联合治疗动脉瘤破裂脑室内出血的分析
DOI：
10.1007/978-3-319-02411-0_8
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Inoue T.
中科院分区：
文献类型：
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作者：
Iwaasa M;Ueba T;Okawa M;Inoue T.
背景：蛛网膜下腔出血（SAH）合并脑室内出血（IVH）与不良预后相关。本研究的目的是评估联合卷绕和神经内窥镜治疗严重SAH合并大量IVH的有效性。方法：2008年4月至2012年3月，在日本福冈大学神经外科治疗了13例大面积IVH伴动脉瘤破裂的患者。所有13例患者均在发病后2天内通过卷取和神经内窥镜切除IVH，包括第四脑室。结果：无再出血及急性脑积水。出院时格拉斯哥结局量表评分（GOS）为：恢复良好（2例），中度残疾（3例），严重疾病（1例），植物人状态（4例），死亡（3例）。6个月时，6例患者的改良Rankin量表评分（mRS）较好（0-2），7例患者的mRS评分较差（3-6）。良好mRS组术前、术后Graeb评分均显著低于对照组（p= 0.020、0.033,mann - whitneu -test）。出院时GOS评分与6个月时mRS评分显著相关（p= 0.011， Fisher精确检验）。结论：联合卷绕和神经内窥镜切除包括第四脑室在内的IVH是可行的手术，并且在大约一半的病例中取得了较好的结果。
Background: Subarachnoid hemorrhage (SAH) with intraventricular hemorrhage (IVH) is associated with poor outcomes. The aim of this study was to evaluate the effectiveness of combined coiling and neuroendoscopy to treat severe SAH with massive IVH.Method: Between April 2008 and March 2012, 13 patients had massive IVH with a ruptured aneurysm treated at the Department of Neurosurgery, Fukuoka University, Japan. All 13 patients were treated within 2 days of onset by coiling and neuroendoscopic removal of the IVH, including the fourth ventricle.Results: No rebleeding or acute hydrocephalus were noted. Glasgow Outcome Scale scores (GOS) at discharge were: good recovery (two patients), moderate disability (three patients), severe disease (one patient), vegetative state (four patients), and dead (three patients). A good modified Rankin Scale score (mRS) (0–2) at 6 months was observed in six patients and a poor mRS score (3–6) occurred in seven. The pre- and post-operative Graeb scores were significantly lower in the good mRS group (p= 0.020 and 0.033, respectively, Mann-WhitneyU-test). GOS scores at discharge were significantly associated with mRS score at 6 months (p= 0.011, Fisher’s Exact Test).Conclusions: Combined coiling and neuroendoscopic removal of the IVH, including the fourth ventricle, were feasible procedures and achieved preferable outcomes in approximately half of the cases.