Cerebrospinal Fluid Drainage In The Early Treatment Of Ruptured Intracranial Aneurysm

Objective:Investigating the influence of perioperative cerebrospinal fluid drainage and different drainage ways for the patients prognosis, summarizing the clinical experience with this method.Methods:This text retrospectively analysised the clinical data of patients from January 2001 to March 2011. During this period, the First Department of Neurosurgery of Jilin University China-Japan Union Hospital treated 229 aSAH patients with the early direct microsurgical(within 72 hours) .There were 219 patients ,excluding 10 patients who abandon treatments after treatment There were 91 males and 128 females, male: female = 0.71:1,age arranging from 20 to 82,an average of 51.56 years old. Hunt-Hess Grade: GradeⅠ51 patients, GradeⅡ79 patients, GradeⅢ55 patients, GradeⅣ28 patients, GradeⅤ6 patients. In the 219 patients, there were 166 patients accepting perioperative cerebrospinal fluid drainage, 36 patients received lumbar drainage and 130 patients received ventricular drainage. There were 53 patients not accepting cerebrospinal fluid drainage. No matter 166 patients in the drainage group accepted lumbar drainage or ventricular drainage, we completed preoperative catheter operation successfully, without any aneurysm rupture due to preoperative catheter operation. We count the prognosis and complications and analysised the obtained data with SPSS17.0 software.χ2test was applied in the enumeration data, rank test was applied in the ranked data. P<0.05 is statistical significance.Results:(1)The prognosis of the patients in drainage group is better than the patients in non-drainage group(P<0.05), cerebrospinal fluid drainage can clearly decline mortality rate(P<0.05). (2) Lumbar drainage compared with ventricular drainage, lumbar drainage can improve the quality of life prognosis (P<0.05). (3) Cerebrospinal fluid drainage can also decline DIND(P<0.05) and not increase the risk of intracranial infection(P>0.05),but it is not obvious that cerebrospinal fluid drainage prevents and treats chronic hydrocephalus.(4) Lumbar drainage compared with ventricular drainage, there is no statistical significance about DIND, chronic hydrocephalus and intracranial infection between the two methods of drainage(P>0.05).Conclusions:(1)Cerebrospinal fluid drainage can reduce the increased intracranial pressure and the damage of intraoperative traction on the brain tissue. Continuous drainage of bloody cerebrospinal fluid can reduce the secondary damage after surgery, improving the quality of the patients'life prognosis and reducing early aneurysmal subarachnoid patients'mortality.(2)Lumbar drainage can promote the cerebrospinal fluid to scour the ventricles and subarachnoid space, avoiding the brain vice injury. So the prognosis of the lumbar drainage group patients'is better than the prognosis of the ventricular drainage group ones'.(3)Continuous drainage of cerebrospinal fluid after operations can remove spasm material from the intraventricular and subarachnoid, thereby it can prevent cerebral vasospasm.(4)Cerebrospinal fluid drainage can remove fibrosing material, reducing the arachnoid fibrosis. If the duration of cerebrospinal fluid drainage is too long, it can increase in the incidence of chronic hydrocephalus.(5)Cerebrospinal fluid drainage can also shorten the operation time, reduce chances of retrograde infection and lumbar puncture times. Therefore, this method can reduce the incidence of infection.(6)Under the premise that intracranial transmural pressure are not changed, cautious cerebrospinal fluid drainage does not cause the aneurysm rupture of the early aneurysmal subarachnoid hemorrhage patients'. Especially,lumbar drainage is more secure and reliable.In summary, in the process of the treatment of early aneurysmal subarachnoid hemorrhage patients, the application of cerebrospinal fluid drainage is a more reasonable choice, of great significance for the prognosis of patients. Lumbar drainage should be the first choice for the treatment of early aneurysmal subarachnoid hemorrhage in most cases.