Diagnosis And Treatment Related Research On Cerebral Vascular Spasm After Subarachnoid Hemorrhage

Subarachnoid Hemorrhage is the most leading cause of stroke. In the United States 25,000 people harbor SAH per year. From the investigation of six cities in china. the annual prevalence of the spontaneous SAH is believed to be 3.1 per 100,000 and the population-based incidence rate is estimated at 4 per 100,000 per year. SAH is a disease that causes severe complications and disability in patients. Re-hemorrhage in 4 weeks and cerebral vasospasm in 4~12 weeks has been demonstrated to be significant predictor of this adverse outcome. Cerebral vasospasm is a common incapacitating complication of SAH. It is divided into acute cerebral vasospasm and delayed cerebral vasospasm. They are different from each other. Morphological change such as vascular cell proliferation in delayed cerebral vasospasm is often found. So once delayed cerebral vasospasm happens, it is difficult to reverse it. Moreover, the use of vasodilator is often noneffective during treating delayed cerebral vasospasm. Because of the secondary ischemic lesion of the brain after delayed cerebral vasospasm, the recovery is knotty. The mass of statistical data shows that cerebral vasospasm is the most serious complication after SAH. The incidence in the general population is estimated between 30 percent and 90 percent. The cerebral vasospasm plays an important role in disability. Since Ecker firstly reported the cerebral vasospasm after SAH, cerebral vasospasm has been the subject of substantial research interest. The endeavor especially focused on the mechanisms, clinical diagnosis and therapy. But the underlying pathogenic mechanism is obcure. So neurosurgeons have to use the clinical diagnostic standard that is from clinical symptom that isn't objective. These years some new therapeutic approach has been brought forward. However, systemic complete therapy remains untoward. This disquisition is focus on the following: 1. By measuring the inner diameters of cranial big blood vessels by using anatomical analysis, digital subtraction angiography and computed tomographic angiography. An objective gist may be obtained. 2. By measuring the concentration of nitrogen monoxide in cerebral spine fluid of the patients and the velocity of blood flow in the middle cerebral artery. An objective standard may be obtained. 3. By using these normal data, a therapy and an integrative approach on the patients suffering from SAH can be evaluated. The inner diameters of cranial main vessels have been measured in cadaver head, DSA and CTA. These data have been compared with each other. There was no significant relation between three groups of parameter (P>0.05). So DSA and CTA can properly provide the parameter of vessel diameter. Meantime these parameters also provide normal scales for estimating cerebral vascular spasm and straitness. By checking the main vessels of the internal carotid artery system. Some data that have been obtained from the patients who are suffering from cerebral vasospasm after SAH show that the vessel diameters have been narrower than normal vessels. There is a significant relationship (p<0.05). So DSA and CTA can embody the changes of the diameters of the vessels. According to our experience, DSA and CTA have their purpose themselves. They supplement each other. A properly conclusion can be drawn by using them appropriately. This experiment shows that in the patients who have suffered from CVS after SAH, there are apparently changes in MCA-VP and NO concentration of CSF for in 3 days. These two parameters correlate each other with state of an illness (ESS). When patients are getting worse (ESS decrease), the MCA-VP increase and the concentration of NO decrease. When patients are getting better (ESS increase), the MCA-VP decrease and the concentration of NO increase. By statistical analysis, there is a linear pertinence between them. Through adopting synthetical analysis approach, the patients with aneurysms have been operated on to clip the aneurysm neck by transcranial approaches. During oper...