Preoperative ventriculostomy and rebleeding after aneurysmal subarachnoid hemorrhage

被引:56
作者
McIver, JI [1 ]
Friedman, JA
Wijdicks, EFM
Piepgras, DG
Pichelmann, MA
Toussaint, LG
McClelland, RL
Nichols, DA
Atkinson, JLD
机构
[1] Mayo Clin, Dept Neurol Surg, Rochester, MN USA
[2] Mayo Clin, Dept Neurol Surg, Rochester, MN USA
[3] Mayo Clin, Dept Neurol, Rochester, MN USA
[4] Mayo Clin, Dept Biostat, Rochester, MN USA
[5] Mayo Clin, Dept Radiol, Rochester, MN USA
关键词
ventriculostomy; aneurysm; subarachnoid hemorrhage; hydrocephalus; rebleeding;
D O I
10.3171/jns.2002.97.5.1042
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Object. Despite the widespread use of ventriculostomy in the treatment of acute hydrocephalus after aneurysmal subarachnoid hemorrhage (SAH), there is no consensus regarding the risk of rebleeding associated with ventriculostomy before aneurysm repair. This present study was conducted to assess the risk of rebleeding after preoperative ventriculostomy in patients with aneurysmal SAH. Methods. The authors reviewed the records of all patients with acute SAH who were treated at a single institution between 1990 and 1997. Thus, the records of 304 consecutive patients in whom an aneurysmal SAH source was documented on angiographic studies and who had presented to the authors' institution within 7 days of ictus were analyzed. Rebleeding was confirmed by evidence of recurrent hemorrhage on computerized tomography scans in all cases. Forty-five patients underwent ventriculostomy for acute hydrocephalus after aneurysmal SAH at least 24 hours before aneurysm repair. Ventriculostomy was performed within 24 hours of SAH in 38 patients, within 24 to 48 hours in three patients, and more than 48 hours after SAH in four patients. The mean time interval between SAH and surgery in patients who did not undergo ventriculostomy was no different from the mean interval between ventficulostomy and surgery in patients who underwent preoperative ventriculostomy (3.6 compared with 3.8 days, p = 0.81). Fourteen (5.4%) of the 259 patients who did not undergo ventriculostomy suffered preoperative aneurysm rebleeding, whereas two (4.4%) of the 45 patients who underwent preoperative ventriculostomy had aneurysm rebleeding. Conclusions. No evidence was found that preoperative ventficulostomy performed after aneurysmal SAH is associated with an increased fisk of aneurysm rebleeding when early aneurysm surgery is performed.
引用
收藏
页码:1042 / 1044
页数:3
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