KMID : 1001920070410020095
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Journal of Korean Neurosurgical Society 2007 Volume.41 No. 2 p.95 ~ p.99
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Effect of Continuous External Ventricular Drainage on Delayed Ischemic Neurologic Deficits after Aneurysmal Clipping in Spontaneous Subarachnoid Hemorrhage
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Ryu Hyeon-Chul
Lim Jun-Seob Cho Kyu-Yong Park Seung-Kyu Kang Nam-Gu Jang Hong-Jeon
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Abstract
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Objective: The purpose of this reports is to describe the influence of continuous external ventricular drainage (EVD) on delayed ischemic neurologic deficit (DIND) after early surgery in ruptured aneurysmal patients.
Methods: The authors reviewed 229 patients with aneurysmal subarachnoid hemorrhage (SAH) who had been treated with clipping at a single institution between 1998 and 2004. Of these, 121 patients underwent continuous EVD (Group A) postoperatively, whereas 108 patients did not (Group B). EVD was performed at ipsilateral Kocher¡¯s point and maintained 2 to 14 days postoperatively.
Results: DIND occurred in 15.7% (19 cases) of patients in Group A, 25% (27 cases) from Group B (P value=0.112). Compared with Group A, Group B was more likely to suffer acute symptom of DIND and showed poor response to 3- H therapy. Major symptoms of DIND in Group A were mild confusion (36.8%) and mild deterioration of mental state (26.3%), contrary to weakness of extremities (59.2%) in Group B. At discharge, Glasgow Outcome Scales (GOS) of Group A were: good recovery (63.2%), moderately disabled (21%), severely disabled (10.5%), dead (5.3%) and Group B : good recovery (48.1%), moderately disabled (37%), severely disabled (14.8%) and dead (0%). Of 121 patients from group A, 35 patients (28.9%) suffered ventriculitis.
Conclusion: Continuous EVD after aneurysmal clipping in patients with SAH reduced the risk of DIND and its sequelae, relieved its symptoms, and improved the outcome.
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KEYWORD
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Aneurysm, Ventriculostomy, Vasospasm, Delayed ischemic neurologic deficits (DIND), Subarachnoid hemorrhage, Ventriculitis
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