Journal of Korean Neurosurgical Society

  • 제41권2호
  • /
  • Pages.95-99
  • /
  • 2007
  • /
  • 2005-3711(pISSN)
  • /
  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
권호 표지

Effect of Continuous External Ventricular Drainage on Delayed Ischemic Neurologic Deficits after Aneurysmal Clipping in Spontaneous Subarachnoid Hemorrhage

  • Ryu, Hyeon-Chul (Department of Neurosurgery, Gwangju Christian Hospital) ;
  • Lim, Jun-Seob (Department of Neurosurgery, Gwangju Christian Hospital) ;
  • Cho, Kyu-Yong (Department of Neurosurgery, Gwangju Christian Hospital) ;
  • Park, Seung-Kyu (Department of Neurosurgery, Gwangju Christian Hospital) ;
  • Kang, Nam-Gu (Department of Neurosurgery, Gwangju Christian Hospital) ;
  • Jang, Hong-Jeon (Department of Neurosurgery, Gwangju Christian Hospital) ;
  • Ok, Young-Cheol (Department of Neurosurgery, Gwangju Christian Hospital)
  • 발행 : 2007.02.28
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

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.

키워드

참고문헌

  1. Aucoin PJ, Kotilainen HR, Gantz NM, Davidson R, Kellogg P, Stone B : Intracranial pressure monitors. Epidemiological study of risk factors and infections. Am J Med 80 : 369-376, 1986 https://doi.org/10.1016/0002-9343(86)90708-4
  2. Bergman TA, Rockswold GL : Cerebrospinal fluid fistulae, in Youmans JR : Neurological surgery, ed 4. Philadelphia : Saunders, 1996, Vol 3, pp1848
  3. Black PMcL : Hydrocephalus and vasospasm after subarachnoid hemorrhage from ruptured intracranial aneurysms. Neurosurgery 18 : 12-16, 1986 https://doi.org/10.1227/00006123-198601000-00003
  4. Clark WC, Muhlbauer MS, Hartman H, Ray MW, Watridge CB : Complications of intracranial pressure monitoring in trauma patients. Neurosurgery 25 : 20-24, 1989 https://doi.org/10.1227/00006123-198907000-00004
  5. Doczi T, Nemessanyi Z, Szegvary Z, Huszka E : Disturbance of cerebrospinal fluid circulation during the acute stage of subarachnoid hemorrhage. Neurosurgery 12 : 435-438, 1983 https://doi.org/10.1227/00006123-198304000-00011
  6. Dorch NWC, King MT: A review of cerebral vasospasm in aneurysmal subarachnoid hemorrhage. Part 1 : incidence and effects. J Clin Neurosci 1 : 19-26, 1994
  7. Dreier JP, Evert N, Priller J, Megow D, Lindauer U, Klee R, et al : Products of hemolysis in the subarachnoid space inducing spreading ischemia in the cortex and focal necrosis in rats : a model for delayed ischemic neurologic deficits after subarachnoid hemorrhage. J Neurosurg 93 : 658-666, 2000 https://doi.org/10.3171/jns.2000.93.4.0658
  8. Hildebrandt G, Werner M, Kaps M, Busse O : Acute non-communicating hydrocephalus after spontaneous subarachnoid hemorrhage. Acta Neurochir (Wien) 76 : 58-61, 1985 https://doi.org/10.1007/BF01403830
  9. Kassell NF, Sasaki T, Colohan AR : Cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Stroke 16 : 562-572, 1985 https://doi.org/10.1161/01.STR.16.4.562
  10. Kassell NF, Torner JC, Jane JA, Adams HP, Konable GN : The International cooperative study on the timing of aneurysm surgery. part 1 : overall management results. J Neurosurg 73 : 18-36, 1990 https://doi.org/10.3171/jns.1990.73.1.0018
  11. Lanzino G, Kassell NF : Double-blind, randomized, vehicle controlled study of high-dose tirilazad mesylate in women with aneurysmal subarachnoid hemorrhage. Part II : A cooperative study in North America. J Neurosurg 90 : 1018-1024, 1999 https://doi.org/10.3171/jns.1999.90.6.1018
  12. Lanzino G, Kassell NF, Dorsch NW, Pasqualin A, Brandt L, Schmied-ek P, et al : Double-blind, randomized, vehicle controlled study of high-dose tirilazad mesylate in women with aneurysmal subarachnoid hemorrhage. Part I. A cooperative study in Europe, Australia, New Zealand, and South Africa. J Neurosurg 90 : 1011-1017, 1999 https://doi.org/10.3171/jns.1999.90.6.1011
  13. Levy DI, Rekate HL, Cherny WB, Manwaring K, Moss SD, Baldwin HZ : Controlled lumbar drainage in pediatric head injury. J Neurosurg 83 : 453-460, 1995 https://doi.org/10.3171/jns.1995.83.3.0453
  14. Mcdonald RL, Weir B : Cerebral Vasospasm. San Diego : Academic Press, 2001
  15. Mayhall CG, Archer NH, Lamb V, Spadora AC, Baggett JW, Ward JD, et al : Ventriculostomy related infections. A prospective epidermiologic study. N Engl J Med 310 : 553-559, 1984 https://doi.org/10.1056/NEJM198403013100903
  16. Ohkuma H, Manabe H, Tanaka M, Suzuki S : Impact of cerebral microcirculatory changes on cerebral blood flow during cerebral vasospasm after aneurysmal subarachnoid hemorrhage. Stroke 31 : 1621-1627, 2000 https://doi.org/10.1161/01.STR.31.7.1621
  17. Ohman J, Servo A, Heiskanen O : Risk factors for cerebral infarction in good-grade patients after aneurysmal subarachnoid hemorrhage and surgery : A prospective study. J Neurosurg 74 : 14-20, 1991 https://doi.org/10.3171/jns.1991.74.1.0014
  18. Paul K Jr, John RWK, Joel DM, Richard HS : Marked reduction of cerebral vasospasm with lumbar drainage of cerebrospinal fluid after subarachnoid hemorrhage. J Neurosurg 100 : 215-224, 2004 https://doi.org/10.3171/jns.2004.100.2.0215
  19. Roland PS, Marple BF, Meyerhoff WL, Mickey B : Complications of lumbar spinal fluid drainage. Otolaryngol Head Neck Surg 107 : 564-569, 1992 https://doi.org/10.1177/019459989210700409
  20. Soustial JF, Levy E, Bibi R, Lukaschuk S, Manor D : Hemodynamic consequences of cerebral vasospasm on perforating arteries : A phantom method study. Stroke 32 : 629-635, 2001 https://doi.org/10.1161/01.STR.32.3.629
  21. Suh DS, Kim BT, Im SB, Cho SJ, Shin WH, Choi SK, et al : Correlation between angiographic vasospasm and clinical vasospasm following aneurysmal subarachnoid hemorrhage. J Korean Neurosurg Soc 29 : 1563-1569, 2000
  22. Vourc'h G : Continuous cerebrospinal fluid drainage by indwelling spinal catheter. Br J Anesthesiol 35 : 118-120, 1963 https://doi.org/10.1093/bja/35.2.118
  23. Yang GJ, Kim MC, Chung H, Lee SP, Choi GW, Yeo HT : Clinical roles of continuous lumbar drainage in acute hydrocephalus patients. J Korean Neurosurg Soc 29 : 644-649, 2000
  24. Yoon SM, Yun IG, Shim JJ, Doh LW, Bae HG, Lee KS : Clinical significance of routine cerebral angiography after cerebral aneurysm surgery. J Korean Neurosurg Soc 35 : 585-591, 2004