The Clinic Application Of CTA And Neuroendoscopy In The Management Of Spontaneous Intraventricular Hemorrhage

Objective:To evaluate the clinic application of CTA and neuroendoscopy in the management of the patients with spontaneous intraventricular hemorrhage.Methods:1. Computed tomographic angiography (CTA) in diagnosis and treatment of spontaneous intraventricular hemorrhage.Sixty-eight patients were accepted voluntarily for both CTA and DSA exams between Jan.2008and May2009. CTA examination was completed within24hours after onset and DSA was completed within72hours. The results of CTA and DSA were analyzed comparatively.2. The effect of neuroendoscopic treatment on spontaneous intraventricular hemorrhage.The data from154cases of spontaneous intraventricular hemorrhage, who were admitted to our hospital between2009June to2011December with no positive finding by CTA was collected. The patients were divided into three groups, neuroendoscopic operation group (48cases), external ventricular drainage group (71cases), microsurgical group (35cases). All operation was performed within48 hours after onset. The comparative study of the operative time, hematoma clearance rate, postoperative complications, ADL score6months after operation was made among those three groups.3. Statistical methodsAll data were analyzed using SPSS13.0software. X2test, analysis of variance and Wilcoxon rank sum test were performed. P<0.05was considered statistically significant.4. Results(1). the application value of CTA in the diagnosis and treatment of the patients with spontaneous intraventricular hemorrhage.In68cases with spontaneous intraventricular hemorrhage, who were accepted both DSA and CTA voluntarily, there were32cases (47.05%) with cerebral vascular disease (CVD) found by DSA, then confirmed in the operation. In which, there were21cases suffered from intracranial aneurysms (ICAs),9cases with cerebral arteriovenous malformations (AVM),1case with moyamoya’s disease. But, there were31cases (45.56%) with CVD found by CTA, one case with intracranial aneurysm which located at the terminal of the anterior cerebral artery (ACA) confirmed by DSA was missed diagnosis. There was no significant difference in the both of positive and negative rate between DSA and CTA proved by statistics analyze (p>0.05).and missed diagnosis rate was3.13%. (2). Neuroendoscopic surgical treatment and effect analysis on spontaneous intraventricular hemorrhage.1) Hematoma clearance rateCT scan was reviewed within6hours after operation, the hematoma clearance rate more than85%in neuroendoscopic group (NEG), microsurgical group(MSG) and external ventricular drainage group(EVDG) were16cases (33.33%),8cases (22.86%),0case between50%-85%were27cases (56.25%),18cases (51.43%), in3cases(4.23%); and less than50%were5cases(10.42%),9(25.71%),68cases (95.77%) respectively. The hematoma clearance rate in NEG was significantly higher than that in the MSG and EVDG (p<0.01).2) Operative time and postoperative complicationsThe operative time of NSG, MSG and EVDG was94.2±26.1min,167.9±54.7min、80.3±33.0min respectively:and post operative complication rates was:12.5%、25.4%、40.6%respectively. The operative time of NEG was obviously shorter and the post operative complication rate of NEG was significantly less compared with MSG and EVDG (p<0.05).3) ADL score at6months after operationThe ADL score were examined at6months after operation, the patients obtained ADL Ⅰ-Ⅲ were considered good recovery. The good recovery rate in NEG, MSG and EVDG was79.17%(38/48),65.71% (23/35), and46.48%(33/71) respectively. The good recovery rate in NEG was significantly better than that in MSG and EVDG (P=0.001).Conclusion1. CTA has high sensitivity in the diagnosis of the cause of spontaneous intraventricular hemorrhage, and has an almost same diagnostic efficiency compared with DSA.2, There is less operative time, higher hematoma clearance rate, fewer complications in NEG, and the prognosis is superior to the MSG and EVDG.The innovation of this clinical study1. The CTA diagnostic value was confirmed obviously by comparative study of CTA and DSA in the diagnosis of spontaneous intraventricular hemorrhage especially for acute and critical patients.2. This is a detailed and objective comparative study on spontaneous intraventricular hemorrhage treated by neuroendoscopic surgery, microsurgical treatment or external ventricular drainage treatment.