| Background and Objective:Acute obstructive hydrocephalus is one of the most dangerous complications of intraventricular hemorrhage or midline lesions that can quickly lead to acute intracranial hypertension crisis-acute foramen magnum herniation, resulting in respiratory and circulatory failure, is a common and dangerous emergency in Neurosurgery, the patient may die in a short time if not timely rescue. In this case, the reduce intracranial pressure drug treatment alone can not curb the vicious cycle and may only delay the treatment, and promote its degradation. Release of part of the cerebrospinal fluid by lateral ventricle puncture and drainage, is the key to rescuing acute foramen magnum herniation,which can avoid the occurrence of hernia, slowing the compression of brain stem. The different ways of ventricular drainage, the effect is uneven. The aim of this study was to investigate the efficacy and the results of rapid small hole cranium-puncture external ventricle drainage in acute obstructive hydrocephalus compared with the traditional Dandy drilling.Methods:Retrospective analysis112Patients rescued by the rapid small hole cranium-puncture external ventricle drainage operation,developed by Zhang Qinglin, Professor of Shandong University. And60cases of conventional Dandy drilling rescue acute obstructive hydrocephalus. Statistics the rescued time consumed and the rate of success, mortality and the rate of complication and converted to shunt reoperation, then analysis and evaluate the rapid small hole cranium-puncture external ventricle drainage operation is efficient and convenient in the emergency treatment for the patients developed acute obstructive hydrocephalus.Results:Rapid small hole cranium-puncture external ventricle drainage operation were performed for112cases of acute cases of obstructive hydrocephalus:of which, the average rescuing time consumed was8.6±2.5minutes,89cases were successfully rescued, accounting for79.46%;13cases were converted to shunt, accounting for14.60%;23cases were died, accounting for20.54%. The cause of death:7cases were died from progressiving cerebral hernia,10cases were died from intracranial rebleeding resulted brainstem dysfunction;3cases were died from upper gastrointestinal hemorrhage,1case was died from intracranial infection,2cases were died from pulmonary infection.In comparison,Dandy’s bored group of28cases, the average rescuing time consumed was26.8±4.9minutes,successful treatment in17cases, accounting for60.71%; occurred transit delayed hydrocephalus shunt reoperation in3cases, accounting for17.64%; death in11cases, accounting for39.29%, the cause of death:brain failure in6cases, intracranial rebleeding2cases; upper gastrointestinal bleeding, intracranial infection and pulmonary infection all in1.Statistical analysis proclaimed that Rapid small hole cranium-puncture external ventricle drainage operation was advanced than Dandy’s and the rescuing time consumed,the rate of successfully rescue and mortality were significantly different between the two groups of patients,(P<0.05);on the other hand, The differences in the rates of transit shunt reoperation between groups were not significant even though Rapid’s is less than Dandy’s (P>0.05).Conclusion and significance:Acute obstructive hydrocephalus is a devastating disorder with high mortality and morbidity rates. For this, rapid small hole cranium-puncture external ventricle drainage is a effective treatment. Its main advantage is that it can even be performed in the emergency room without removing the patient from the bed and the valuable time could be gained for the patient developed acute obstructive hydrocephalus to the next examination and treatment, at the same time other methods such as melting hematoma with urokinase could be complemented, and the delayed hydrocephalus maybe effectively declined after the cerebrospinal fluid circulation was early recovered,and the rate of converted shunt reoperation was reduced maximally.therefore, rapid small hole cranium-puncture external ventricle drainage operation not only achieved good therapeutic effect,but received significant social benefit, is a life-saving and effective procedure that should be widely performed in patients who developed acute obstructive hydrocephalus. |
PDF Full Text Request