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KMID : 1005420060080010048
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Journal of Cerebrovascular and Endovascular Neurosurgery
2006 Volume.8 No. 1 p.48 ~ p.55
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Influence of Intraoperative Ventriculostomy on the Occurrence of Shunt-Dependent Hydrocephalus in Aneurysmal Subarachnoid Hemorrhage
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Cho Tae-Koo
Kim Jae-Min
Kim Sung-Soo
Yi Hyeong-Joong
Cheong Jin-Hwan
Bak Koang-Hum
Kim Choong-Hyun
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Abstract
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Objective: Neurosurgeons occasionally advocated intraoperative ventriculostomy to prevent traumatic brain retraction because of severe brain swelling in an acute stage of aneurysmal subarachnoid hemorrhage (SAH) surgery. The authors investigated the impact of the intraoperative ventriculostomy on the occurrence of shunt-dependent hydrocephalus in acute SAH.
Methods: The data of 141 ruptured aneurysm patients who underwent aneurysmal neck clipping in an acute stage were retrospectively reviewed. The patients were divided into three groups according to the cerebrospinal fluid (CSF) drainage amount via intraoperative ventriculostomy. Group 1 (n=44) included the patients who were not performed the intraoperative ventriculostomy, Group 2 (n=34) consisted of patients who were drained the CSF less than 40 cc (< 40 cc) via intraoperative ventriculostomy, and Group 3 (n=63) drained the CSF more than 40 cc (> or = 40 cc). By using statistical methods, the authors analyzed the influences of various variables including Hunt-Hess grade, Fisher grade, Glasgow coma scale, Glasgow outcome scale, presence of acute hydrocephalus and intraventricular hemorrhage (IVH) at admission on the occurrence of hydrocephalus. And also, we analyzed the relationships among the cisternal drainage, lamina terminalis fenestration, and the shunt-dependent hydrocephalus.
Results: Concerning the amount of CSF drainage via intraoperative ventriculostomy, the incidence of shunt-dependent hydrocephalus did not show any difference in three groups (p=0.146). Presence of the acute hydrocephalus, lamina terminalis fenestration, and cisternal drainage did not exert any influence on the incidence of shunt-dependent hydrocephalus, respectively (p=0.124, p=0.168, p=0.452). However, the incidence of shunt-dependent hydrocephalus in patients who had IVH at admission was significantly higher than in who did not have (p=0.010).
Conclusions: Routine intraoperative ventriculostomy dose not increase the incidence of shunt-dependent hydrocephalus. Moreover, it obtains an adequate intraoperative brain relaxation, which results in the decrease of the brain retraction injury and the operation time.
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KEYWORD
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Ventriculostomy, Hydrocephalus, Shunt, Aneurysm, Subarachnoid hemorrhage
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