Prognostic observation of ultra-early emergency embolizaltion and continuous lumbar drainage for high grade intracranial aneurysms

doi:10.3877/cma.j.issn.2095-9141.2018.05.003

Abstract

Abstract:

Objective

To observe the prognosis of patients with Hunt-Hess grade Ⅳ-Ⅴ of intracranial saccular aneurysms who were treated with ultra-early emergency embolization and continuous lumbar drainage.

Methods

The clinical date of 32 patients with Hunt-Hess grade Ⅳ-Ⅴ intracranial saccular aneurysm (grade Ⅳ, n=24 and grade Ⅴ, n=8) admitted from January 2014 to December 2017 were analyzed retrospectively. Sixteen cases of them were treated with ultra-early emergency embolization and continuous lumbar drainage (group A) and 16 underwent emergency embolization (group B). The neurological prognosis of the patients was evaluated at 1, 3 and 6 months after treatment. According to head CT, TCD and clinical manifestation of postoperative patients, we determined whether there were cerebrovascular spasm, hydrocephalus and cerebral infarction, and counted the hospitalization time of the two groups.

Results

Group A has 5 patients with cerebral vasospasm, 9 patients with hydrocephalus, 6 patients with cerebral infarction and patients were in hospital for (25±8) d. Group B has 8 patients with cerebral vasospasm, 11 patients with hydrocephalus, 9 patients with cerebral infarction and patients were in hospital for (28±9) d. There was no significant difference in GCS between the group A and group B at 1 month after treatment (P>0.05); but there was significant difference in Rankin prognostic scores at 3 and 6 months after treatment between the 2 groups (P<0.05).

Conclusion

Ultra-early emergency embolization and continuous lumbar drainage can reduce the number of patients of cerebral vasospasm, hydrocephalus and cerebral infarction, and reduce the time of hospitalization, and improve the recovery level of 3 months and half a year after treatment.

Key words: High grade subarachnoid hemorrhage, Intracranial aneurysms, Continuous lumbar drainage, Interventional therapy

Gen Zhou, Dongfeng Deng, Bin Dong, Xuxin Zhang, Yanzhao Li. Prognostic observation of ultra-early emergency embolizaltion and continuous lumbar drainage for high grade intracranial aneurysms[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2018, 04(05): 264-267.

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References 21

[1]	Zacharia BE, Hickman ZL, Grobelny BT, et al. Epidemiology of aneurysmal subarachnoid hemorrhage[J]. Neyrosurg Clin N Am, 2010, 21(2): 221-223.
[2]	Komotar RJ, Schmidt JM, Starke RM, et al. Resuscitation and critical care of poor-grade subarachnoid hemorrhage[J]. Neurosurgery, 2009, 64(3): 397-410; discussion 410-411.
[3]	Molyneux AJ, Kerr RS, Birks J, et al. Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-up[J]. Lancet Neurol, 2009, 8(5): 427-433.
[4]	Rosengart AJ, Schultheiss KE, Tolentino J, et al. Prognostic factors for outcome in patients with aneurysmal subarachnoid hemorrhage[J]. Stroke, 2007, 38(8): 2315-2321.
[5]	Huang AP, Arora S, Wintermark M, et al. Perfusion computed tomographic imaging and surgical selection with patients after poor-grade aneurysmal subarachnoid hemorrhage[J]. Neurosurgery, 2010, 67(4): 964-974.
[6]	Suarez JI, Tarr RW, Selman WR. Aneurysmal subarachnoid hemorrhage[J]. N Engl J Med, 2006, 354(4): 387-396.
[7]	Janjua N, Mayer SA. Cerebral vasospasm after subarachnoid hemorrhage[J]. Curr Opin Crit Care, 2003, 9(2): 113-119.
[8]	Cupta V, Chinchure SD, Goe C, et al. Coil embolization of intracranial aneurysm in polyarteritis nodosa. A case report and review of the literature[J]. Interv Neuroradiol, 2013, 19(2): 203-208.
[9]	Macdonald RL, Amidei C, Lin G, et al. Safety of perioperative subcutaneous heparin for prophylaxis of venous thromboembolism in patients undergoing craniotomy[J]. Neurosurgery, 1999, 45(2): 245-251.
[10]	Ray WZ, Strom RG, Blackburn SL, et al. Incidence of deep venous thrombosis after subarachnoid hemorrhage[J]. J Neurosurg, 2009, 110(5): 1010-1014.
[11]	陈军辉，王玉海，杨理空,等.手术治疗高级别颅内动脉瘤合并血肿的预后因素分析[J].中华神经外科杂志, 2015, 31(2): 158-160.
[12]	陈军辉，王玉海.颅内动脉瘤的治疗进展[J].中国临床神经外科杂志, 2015, 20(4): 251-253.
[13]	Zhao B, Tan X, Zhao Y, et al. Variation in patient characteristics and outcomes between early and delayed surgery in poor-grade aneurysmal subarachnoid hemorrhage[J]. Neurosugry, 2015, 78(2): 224-231.
[14]	秦尚振，马廉亭，杨铭,等.高级别颅内动脉瘤治疗策略探讨[J].中华神经外科杂志, 2013, 29(9): 916-919.
[15]	Witiw CD, Ibrahim GM, Fllah A, et al. Early predictors of prolonged stay in a critical care unit following aneurysmal subarachnoid hemorrhage[J]. Neurcrit Care, 2013, 18(3): 291-297.
[16]	Aoyama T, Hida K. Spinal intradural granuloma as a complication of an infected cerebrospinal fluid drainage tube fragment--case report[J]. Neurol Med Chir(Tokyo), 2010, 50(2): 165-167.
[17]	赵忠江.早期腰大池持续引流对动脉瘤性蛛网膜下腔出血术后并发症的疗效观察[J].中华老年心脑血管病杂志, 2006, 8(9): 616-618.
[18]	Deruty R, Pelissou-Guyotat I, Mottolese C, et al. Level of consciousness and age as prognostic factors in aneurysmal SAH[J]. Acta Neurochir(Wien), 1995, 132(1): 1-8.
[19]	Laidlaw JD, Siu KH. Ultra-early surgery for aneurysmal subarachnoid hemorrhage: outcomes for a consecutive series of 391 patients not selected by grade or age[J]. J Neurosurg, 2002, 97(2): 250-258, discussion 247-249.
[20]	Pan JW, Zhan RY, Wen L, et al. Ultra-early surgery for poor-grade intracranial aneurysmal subarachnoid hemorrhage:a preliminary study[J]. Yonsei Med J, 2009, 50(4): 521-524.
[21]	陈磊，王玉海，蔡学见,等.重型、特重型颅脑外伤性脑梗死相关危险因素分析[J].中华神经外科杂志, 2011, 27(4): 387-390.

组别	例数	年龄（±s，岁）	动脉瘤瘤颈（±s，mm）	Hunt-Hess分级
组别	例数	年龄（±s，岁）	动脉瘤瘤颈（±s，mm）	Ⅳ级	Ⅴ级
A组	16	53±12	8.7±0.3	12	4
B组	16	54±11	8.4±0.6	12	4
t/χ²值	?	0.213	1.796	1	1
P值	?	0.732	0.086	0.352	0.352

组别	例数	年龄（±s，岁）	动脉瘤瘤颈（±s，mm）	Hunt-Hess分级
组别	例数	年龄（±s，岁）	动脉瘤瘤颈（±s，mm）	Ⅳ级	Ⅴ级
A组	16	53±12	8.7±0.3	12	4
B组	16	54±11	8.4±0.6	12	4
t/χ²值	?	0.213	1.796	1	1
P值	?	0.732	0.086	0.352	0.352

组别	例数	住院时间（d）	GCS评分		改良Rankin量表评分
组别	例数	住院时间（d）	术前	术后1个月	术后3个月	术后6个月
A组	16	25±8	3.8±1.3	3.7±1.4	3.0±1.2	2.4±1.2
B组	16	28±9	3.7±1.3	3.8±1.3	4.2±0.8	3.5±1.5
t值	?	?	0.218	0.210	3.324	2.287
P值	?	?	0.735	0.826	0.004	0.038

组别	例数	住院时间（d）	GCS评分		改良Rankin量表评分
组别	例数	住院时间（d）	术前	术后1个月	术后3个月	术后6个月
A组	16	25±8	3.8±1.3	3.7±1.4	3.0±1.2	2.4±1.2
B组	16	28±9	3.7±1.3	3.8±1.3	4.2±0.8	3.5±1.5
t值	?	?	0.218	0.210	3.324	2.287
P值	?	?	0.735	0.826	0.004	0.038

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