| Objective: Hydrocephalus is the most common complications of subarachnoid hemorrhage caused by ruptured aneurysm.Most of hydrocephalus need surgical treatment that cause great healthy and economic burden for patients.The Liliequist membrane is important in the pathway of CSF circulation,which was mentioned by many researchers that it is related with SAH postoperative hydrocephalus.This study is aimed to assess the effect of Liliequist membrane opening on the prevention of postoperative hydrocephalus.The main objective: to study the effect of Liliequist membrane opening on the prevention of postoperative hydrocephalus;to know the complications of this procedure;to analyze the possible mechanism.Methods: This study was the prospective randomized controlled clinical study.SAH patients caused by ruptured intracranial aneurysm were enrolled in this study from January 2016 to July 2016.The inclusion criteria:(1)Hunt &Hess Grade I-IV SAH patients;(2)SAH caused by ruptured intracranial aneurysm confirmed by DSA or CTA;(3)surgical clipping;(4)no other Intracranial lesions;(5)without severe diseases of other systems;(6)signing of Informed consent of random clinical trial.The exclusion criteria:(1)no aneurysm;(2)intervention therapy;(3)Hunt & Hess Grade V SAH patients.The enrolled patients were randomly assigned into two groups.The patient in group A underwent standard aneurysm clipping with the opening of Liliequist membrane,and the patient in group B underwent same surgery without Liliequist membrane opening.Intraventricular external drainage was gived to the hydrocephalic patient before operation.Symptomatic treatment was gived to the postoperative patient.Discharge standard: The patient could be discharged if he was none of symptoms caused by intracranial hypertension,none of cerebrospinal fluid abnormalities,intracranial hemorrhage absorbed in head CT scan.A 6-month postoperative follow-up was conducted for the observation of hydrocephalus.The major endpoint event included acute hydrocephalus,chronic hydrocephalus,and shunt dependent hydrocephalus.The minor endpoint event included bleeding volume,postoperative hospitalization time,medical expense,new symptomatic cerebral infarction,injury of intracranial artery or nerve,postoperative infection,and recurrence of aneurysm.Statistical method: SPSS 23.0 software package was applied for statistical analysis.The mean value ± standard deviation was adopted by quantitative data of two group patients.Chi-square test was adopted by qualitative data of the major endpoint event and the minor endpoint event.Variance analysis was adopted by quantitative data of the major endpoint event and the minor endpoint event.It would be considered statistically significant if P<0.05.Results: A total of 97 SAH patients were included in this clinical trail.51 patients were assigned into group A.46 patients were assigned into group B.There wasn’t statistically significant(P>0.05)that general information of two groups patients : gender,age,aneurysm location,Hunt & Hess grade,Fisher grade,GCS,disease time,the number of lumbar cistern drainage,etc.The major endpoint event : in group A,hydrocephalus was noted in 14 cases before operation and drainage were administered,acute hydrocephalus was noted in 3 cases after operation,chronic hydrocephalus was noted in 11 cases,6 patients underwent v-p shunt.In group B,hydrocephalus was noted in 12 cases before operation and drainage were administered,acute hydrocephalus was noted in 9 cases after operation,chronic hydrocephalus was noted in 20 cases,12 patients underwent v-p shunt.The minor endpoint event: in group A,the average bleeding volume in operation was 481.2ml,the postoperative hospitalization time was 11.6 days,the average medical expense of 6 months after operation was 79892 RMB,new symptomatic cerebral infarction was noted in 5 cases,postoperative infection in 3 cases,and aneurysm recurrence in 2 cases,no artery or nerve injury.In group B,the average bleeding volumein operation was 500.9ml,the postoperative hospitalization time was 12.1 days,the average medical expense of 6 months after operation was 107922 RMB,new symptomatic cerebral infarction was noted in 4 cases,postoperative infection in 2 cases,and aneurysm recurrence in 1 cases,no artery or nerve injury.The rate of acute and chronic hydrocephalus in group A was obviously decreased than group B.The average medical expense of group A was obviously lower than group B.There was statistically significant(P<0.05)in both groups.The bleeding volume,postoperative hospitalization time,new symptomatic cerebral infarction,postoperative infection and recurrence of aneurysm wasn’t statistically significant(P>0.05)in both groups.Conclusion: Aneurysm clipping with Liliequist membrane opening can effectively decrease the occurrence of acute and chronic hydrocephalus without injury of intracranial artery or nerve.The number of v-p shunt obviously decrease.The average medical expense of 6 months after operation obviously decrease.We recommend this procedure to any patient with ruptured aneurysm in surgical clipping. |
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