Effect Of Lumbar Cistern Drainage On Prevention And Treatment Of Hydrocephalus After Ruptured Intracranial Aneurysm Embolization

ObjectiveTo investigate the feasibility of drainage of lumbar plexus in prevention and treatment of hydrocephalus after aneurysm subarachnoid thrombosis.Compared with the release of cerebrospinal fluid from simple lumbar puncture,evaluated the clinical efficacy of lumbar drainage in the prevention and treatment of hydrocephalus after aSAH embolization MethodsSelected from the Department of Neurosurgery at the Second Affiliated Hospital of Nanchang University,from March 2016 to September 2017,a total of 106 cases were complete.The patients diagnosed with cerebral aneurysmal subarachnoid hemorrhage by brain CTA or DSA were all within 48 hours of admission.Under general anesthesia,intracranial aneurysm interventional embolization was performed.They were randomly divided into observation group and control group,including 57 cases in the observation group and 49 cases in the control group.All patients were dehydrated and hypotensive after endovascular treatment to prevent seizures,nimodipine against cerebral vasospasm,gastrointestinal protection and rehydration.The control group received routine lumbar puncture to release cerebrospinal fluid on a daily or alternate day basis.A single drainage of blood cerebrospinal fluid(CSF)was about 10-35 mL.When the head CT scan showed that the intracranial hemorrhage was basically or already absorbed,the meningeal irritation sign was negative.Significant improvement in headache symptoms,cerebrospinal fluid test results in the normal range or near normal stop lumbar puncture,the average puncture 4.3 times.In the observation group,intracranial aneurysm interventional embolization was satisfactory.Within 24 hours after the interventional embolization in the ward,blood draining cerebrospinal fluid was continuously placed in the ward and the daily drainage volume was recorded in detail.The relative height of the drainage bottle and the external auditory canal was adjusted in time;extubation index with the control group,the average drainage of 7.2 days;to prevent retrograde infection,even if the continuous drainage of cerebrospinal fluid red blood cell count is still greater than 100 × 106 / L,also Need to remove the drainage tube to stop drainage,such as the condition needs,can be replaced by a lumbar intervertebral space again catheter drainage.Both groups were reexamination of brain subacromial hemorrhage and hydrocephalus on the second,fifth and tenth days after operation.CSF pressure and CSF RBC were recorded every other day;the symptoms of the patients improved and the meningeal irritation was relieved.Results1 In 49 cases of intracranial aneurysms,10 cases of acute cerebral hydrocephalus(20.41%)were involved in intracranial aneurysm.After symptomatic treatment,9 cases were relieved;1 case was treated with ventriculoperitoneal shunt at 2 months after operation.In the observation group of 57 patients,there were 4 cases of acute hydrocephalus(7.02%),all of which relieved after symptomatic treatment;2 there was no significant difference in cerebrospinal fluid pressure and RBC on the first day,and the indicators were obvious on the 3rd,7th,and 9th days in the study group.Lower than the control group,the difference was statistically significant(P <0.05).3The recovery time of intracranial pressure was compared between the two groups.The study group was shorter than the control group,and the difference was statistically significant(P<0.05).conclusion1.Continuous drainage of bloody cerebrospinal fluid in the lumbar cisterns for intracranial aneurysm intravascular treatment of aneurysmal subarachnoid hemorrhage can significantly accelerate the clearance rate of intracranial hemorrhage,shorten the time of headache for patients,reduce the length of hospital stay,and reduce hospitalization.cost;2.The operation of the external drainage of the lumbar pool is continuous operation,continuous drainage,and the curative effect is definite.Compared with conventional lumbar puncture,it is more easily accepted by patients and their families.3,the operation and drainage process should pay close attention to low intracranial pressure,cerebral hernia and intracranial infection and other complications.