| Subarachnoid hemorrhage caused by rupture of intracranial aneurysm is a kind of cerebral vascular disease,which is very harmful to the patients.,many to receive timely surgical treatment of patients with serious prognosis because of its complications.Hydrocephalus is one of the most common complications.Hydrocephalus is one of the common complications,patients often appear indifferent/apathy,dementia,walking instability,urinary incontinence and other symptoms,serious impact on the quality of life,most patients need reoperation.lamina terminalis was originally used in aneurysm clipping surgery to btain a more wide operating space,then many retrospective studies consider that lamina terminalis has a certain significance to the prevention and treatment of hydrocephalus after aneurismal subarachnoid hemorrhage.Objective:To investigate the therapeutic and preventive effect of fenestration of the lamina terminalis on the hydrocephalus after aneurysmal subarachnoid hemorrhage in the clipping of anterior communicating artery aneurysms Method:Methods:Review collecte the data of patients with ruptured anterior communicating artery aneurysm treated by surgery from September 2014 to August 2016 were collected from the Department of Neurosurgery,China Japan Union Hospital,Jilin University.Into the case according to the following criteria.(1)the onset of acute spontaneous subarachnoid hemorrhage,and the computed tomography angiography(Computed tomography angiography,CTA)or digital subtraction angiography(Digital subtraction DSA)confirmed the anterior communicating artery aneurysm,(2)Preoperative Hunt-Hess classification for stage I to IV,Fisher classification for patients with grade 1 to grade 4,(3)The patients without severe basic medical history about breathing,circulation,blood system and so on,can tolerate surgery,(4)Before the onset of the disease,there was no other medical history in Department of neurosurgery and common symptoms of hydrocephalus,(5)The patient or the patient's authorized client requires microsurgery and sign informed consent,(6)The best operation time was within 72 hours after onset.(7)Postoperative follow-up was more than 3 months.A total of 123 cases were included,68 men and 55 women.Among them?There are 52 patients with Hunt-Hess Grade I-II,71 patients with Hunt-Hess Grade III-IV,53 patients with Fisher Grade 1-2,70 patients with Fisher Grade 3-4.They were divided into the fenestration of the lamina terminalis group(FLT)and the simple clipping group(NON-FLT)according to whether or not fenestration of the lamina terminalis.There are 51 patients in the FLT group and 72 patients in the NON-FLT group.The age of FLT group is 54.42±7.1 years old and NON-FLT group is 53.76±6.7 years old.There are 48 cases of preoperative acute hydrocephalus,including 17 cases in the FLT group,and 31 cases in the NON-FLT group.A total of 40 cases were performed in undergoing shunt surgery,including 7 cases in the FLT group,and 33 cases in NON-FLT group.The ventricle of the two groups of patients 1 month before and after surgery was measured and analyzed statistically.Statistical analysis of the therapeutic effect of fenestration of the lamina terminalis on acute hydrocephalus and the preventive effect of fenestration of the lamina terminalis on the post-a SAH shunt dependent hydrocephalus was conducted and analyzed in different Hunt-Hess Grade and Fisher Grade.Results:The two groups of patients with pre-operation acute hydrocephalus and post-operation hydrocephalus relief are compared with a result of P< 0.05,which means that there is a statistical difference.The two groups of patients with shunt-dependent hydrocephalus are compared with a result of P<0.05,which is statistically significant.Compared the patients with shunt-dependent hydrocephalus in the different grade,in patients with Hunt-Hess Grade I-II,P > 0.05,which is not statistically significant;in patients with Hunt-Hess Grade III-IV,P < 0.05,which is statistically significant;in patients with Fisher Grade 1-2,P > 0.05,which is not statistically significant;in patients with Fisher Grade 3-4,P<0.05,which is statistically significant.The measured values P of pre-operation each ventricle were more than 0.05 in the two groups of patients,which is not statistically significant;the measured values P of post-operation each ventricle were less than 0.05,which is statistically significant.Conclusion:Early craniotomy for the treatment of ruptured anterior communicating artery aneurysm and fenestration of the lamina terminalis at the same time is a safe mode of operation,which can effectively alleviate the post-a SAH expansion of the ventricle of patients,has a good therapeutic effect on hydrocephalus occurred prior to ruptured anterior communicating artery aneurysm surgery.It can effectively prevent post-operation shunt-dependent hydrocephalus of ruptured anterior communicating artery aneurysm patients,especially for patients with Hunt-Hess Grade 3-4 and Fisher Grade 3-4 have significant results.It is recommended to be routinely used in the aneurysm clipping surgery for the above classification of patients with ruptured anterior communicating artery aneurysm... |
PDF Full Text Request