The role of lumbar drainage in symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage / 中华急诊医学杂志

Objective To investigate the risk factors of symptomatic vasospasm after aneurysmal subarachnoid hemorrhage and evaluate the effect of lumbar drainage of cerebrospinal fluid on vasospasm.Methods In this retrospective controlled-cohort study, 175 patients with aneurysmal subarachnoid hemorrhage met our study criteria between January 2012 and December 2013.By multi-factor regression analysis, gender, age, Hunt-Hess grade, modified Fisher grade and lumbar drainage were analyzed.The outcomes were assessed by the presence or absence of symptomatic cerebral vasospasm and vasospasm-related infarction, and the mean days of hospital stay and score of Glasgow Outcome Scale at 1-month follow-up.Results Several factors affected the prognosis of subarachnoid hemorrhage.Lumbar drainage was a protective factor of symptomatic cerebral vasospasm (OR =0.243, 95％ CI: 0.119-0.497) and vasospasm-related infarction (OR =0.305, 95％ CI: 0.154-0.604).The patients with lumbar drainage had higher score of Glasgow Outcome Scale (P ＜ 0.05).But the patients with lumbar drainage had longer hospital stay (P ＜ 0.05).Conclusions Lumbar drainage of cerebrospinal fluid after aneurysmal subarachnoid hemorrhage markedly reduced the risk of symptomatic cerebral vasospasm and improved outcome.

Hunt-Hess and Fisher Grades as Predicting Factors for Chronic Hydrocephalus in Surgically Treated Ruptured Aneurysm

OBJECTIVE: The popular grading systems in use, such as Hunt-Hess grade and Fisher scale score, are based primarily on the patient's clinical conditions or computerized tomography score after aneurysmal subarachnoid hemorrhage(SAH). The author investigated whether the need for ventriculoperitoneal(VP) shunt for chronic hydrocephalus and outcome can be predicted by Hunt-Hess grade and Fisher scale. METHODS: A series of 146 patients admitted to our hospital from August 1991 to July 1999, who presented with SAH and underwent craniotomy for aneurysm clipping were studied retrospectively. Chronic hydrocephalus was defined as clinically and radiographically demonstrated hydrocephalus that lasted 2 weeks or longer after initial hemorrhage which required shunting. Patients were evaluated based on following factors: Hunt-Hess grade, Fisher scale, age, sex, hypertension, aneurysm location, and intervals from aneurysm rupture to operation. RESULTS: The overall mortality rate of the study group was 8.2%. Hunt-Hess grade(p=0.001) or Fisher scale (p=0.001) at all pretreatment times was significantly correlated with outcome. In addition, there was an increased risk of poor outcome in older age(650.05). Of 134 surviving patients, 16 patients(12%) underwent VP shunt placement secondary to chronic hydrocephalus. Hunt-Hess grade(p=0.001) is more predictive of chronic hydrocephalus than Fisher scale(p=0.146). Aneurysm location was significantly correlated with development of chronic hydrocephalus (p<0.05), without significant correlations in sex, age, hypertension. IVH, and ICH. CONCLUSION: This study suggests that there is a high clinical correlation between outcome and Hunt-Hess grades and Fisher scales on admission, but Hunt-Hess grade is more predictive for chronic hydrocephalus than Fisher scale. In addition, age(<65 yrs) is the significant factor for prediction of outcome. There was a trend of increasing risk for chronic hydrocephalus according to aneurymal location.

Clinical Analysis of Surgically Treated 134 Cases of Anterior Communicating Artery Aneurysms

This study is a retrospective clinical analysis of 134 cases of anterior communicating artery aneurysms surgically treated in the Department of Neurosurgery, Chungnam National University Hospital from January 1990 to December 1996. The results of analysis were summarized as follows; 1) Peak age incidence was in the sixth decade and male to female ratio was 1: 1.2, showing female predominancy. 2) There was no statistically significant relationship between direction of aneurysm and Fisher's grade, and occurrence of hydrocephalus, and also between the direction, size and shape of aneurysm and preoperative Hunt-Hess grade. 3) There was statistically significant relationship between the shape of aneurysm and angiographic vasospasm; there was high incidence of vasospasm in lobulated and oval shape of aneurysm. But there was no statistically significant relationship between the direction, size of aneurysm and angiographic vasospasm. 4) The correlations between outcome and preoperative Hunt-Hess grade, and occurrence of angiographic vasospasm, and temporary clipping were statistically significant; the outcome was good in cases of no vasospasm, temporay clipping and better preoperative Hunt-Hess grade. 5) The direction, shape and size of aneurysm, existence or not of abnormality in circle of willis, timing of surgery and operative procedure had no statistically significant relationship with outcome. 6) Postoperative complications were vasospasm and infarction(18.7%), brain edema, hydrocephalus, in order of frequency, and the mortality rate was 3%.