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Objective:To investigate the clinical value of hematoma volume estimated by 3D-Slicer in predicting symptomatic cerebral vasospasm (sCVS) after aneurysmal subarachnoid hemorrhage (aSAH).Methods:CT images on admission of 84 aSAH patients, admitted to our hospital from January 2018 to June 2021, were collected. The hematoma volume of these patients was measured by 3D-Slicer (3D-Slicer hematoma volume). Patients were divided into sCVS group and non-sCVS group according to the occurrence of postoperative sCVS. The differences of 3D-Slicer hematoma volume, Fisher grading scale and modified Fisher grading scale between the two groups were compared by statistical methods, and the independent risk factors for sCVS after aSAH were screened. The differences of 3D-Slicer hematoma volume among patients with different Fisher grading scale or modified Fisher grading scale were compared.Results:There was no significant difference in Fisher grading scale and modified Fisher grading scale between sCVS group and non-SCVS group ( P>0.05), but the 3D-Slicer hematoma volume in sCVS group was significantly larger than that in non-SCVS group ( P<0.05). 3D-Slicer hematoma volume ( OR=1.061, 95%CI: 1.004-1.120, P=0.034) was independent risk factors for sCVS after aSAH. The comparison of 3D-Slicer hematoma volume among patients with different Fisher grading scale or modified Fisher grading scale showed statistical difference ( P<0.05). Conclusion:As compared with Fisher grading scale and modified Fisher grading scale, the hematoma volume measured by 3D-Slicer has more advantage in predicting sCVS after aSAH.
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Objective To investigate the effect ofcranioplasty on prognosis of patients accepted intracranial aneurysm clipping combined with simultaneous decompressive craniectomy.Methods One hundred and forty-four patients accepted intracranial aneurysm clipping combined with simultaneous decompressive craniectomy (first-stage operation) in our hospital from January 2013 to June 2017 were chosen;there were 56 patients without cranioplasty in the control group and 88 patients with cranioplasty (second-stage operation) in the observation group.The degrees of coma before first-stage operation were assessed by Glasgow coma scale (GCS).The general state three months after first-stage operation was assessed by GCS and activity of daily living (ADL) scale.The prognoses of these patients 9 and 15 months after first-stage operation were assessed by Glasgow outcome scale (GOS) and ADL scale.The clinical data,prognoses and incidence of hydrocephalus of patients from the two groups were compared.Related factors associated with hydrocephalus were analyzed by multivariate Logistic regression analysis.Results GCS,GOS and ADL scale scores in the observation group 9 and 15 months after first-stage operation were all significantly higher than those in the control group (P＜0.05);incidence of hydrocephalus in the observation group after first-stage operation (31.82％) was significantly lower than that in the control group (62.5％,P＜0.05).Logistic regression model revealed that cranioplasty,Hunt-Hess grading and Fisher grading were independent related factors for incidence of hydrocephalus (P＜0.05);cranioplasty was the protective factor of hydrocephalus (OR=0.126),and Hunt-Hess grading and Fisher grading were the risk factors of hydrocephalus (OR=5.311 and 5.073).Conclusion Cranioplasty can reduce the incidence of hydrocephalus and improve the prognosis of patients accepted intracranial aneurysm clipping combined with simultaneous decompressive craniectomy.