| BackgroundAneurysmal subarachnoid hemorrhage is a common disease and a serious prognosis.About 10%of all acute cerebral apoplexy are primary subarachnoid hemorrhage,and the proportion of the number of patients with cerebral aneurysm rupture and bleeding is about85%in the cause of subarachnoid hemorrhage,and the main surgical treatment is two kinds of surgical methods:craniotomy and interventional embolization.Which method is better mainly depending on the patient's comprehensive condition,besides the subarachnoid hemorrhage to the early nerve damage factor,the occurrence of chronic hydrocephalus is also a key factor that affects the patient's prognosis.This paper analyzes the related factors that may lead to it.ObjectiveObjective To compare the incidence of chronic hydrocephalus after craniotomy clipping and endovascular embolization in patients with ruptured intracranial aneurysms and its related factors.MethodsThe 562 patients selected were from the First Affiliated Hospital of our university in Jan 1st,2012 to Jun 30st,2015,the number of cases treated as the object of this study.Inclusion criteria:1.patients or patient's permission,that condition according to the principle of voluntary choice whether craniotomy treatment and endovascular embolization therapy;2.patients with symptoms and signs of SAH,parallel lumbar puncture or cranial CT scan imaging confirmed 3.according to SAH;the head CTA examination results and cerebral angiography confirmed and the diagnosis of intracranial aneurysms.Exclusion criteria:1.patients before admission has been diagnosed as patients with hydrocephalus;2.the onset time is less than 72h or less,and do not offer head CT or CTA examination results;3.patients with SAH,but by head CTA or DSA after SAH intracranial aneurysm rupture bleeding 4.;patients found by health examination for 0 unruptured aneurysms;5.died within 3 weeks;6.patients caused by SAH disease because of cancer,moyamoya disease,AVM or trauma;7.patients;8.patients admitted to the hospital after underwent endovascular surgery,because of the other situation again patients with craniotomy.Detailed review of patient records,a retrospective analysis of the basic information in accordance with the conditions of screening patients including age,gender,smoking history,drinking history,history of hypertension,aneurysm location,aneurysm size,high grade and high grade Hunt-Hess grade Fisher grade.The patients were followed up and watch the admission data after brain CT or CTA imaging,imaging data for patients within72 hours and 21 days later than the head CT to Fisher grade,with bleeding after more than21 days as head CT diagnostic criteria of chronic hydrocephalus.The diagnostic criteria for hydrocephalus were evaluated by selecting the results of the skull CT imaging examination for hospitalized patients more than>3 weeks after the diagnosis of aSAH.The diagnosis standard is:the tip of the rostrum lateral ventricles from>45mm;the third ventricle width of>6mm;the article on both sides of the caudate nucleus edge distance>25mm;the fourth ventricle width>20mm.Hydrocephalus can be diagnosed as long as any of the above criteria are met and the imaging findings of primary cerebral atrophy are excluded.First,the patients were divided into two groups according to different surgical methods:craniotomy and intravascular interventional embolization.The effect of craniotomy and intravascular embolization on the incidence of chronic hydrocephalus in patients with cerebral aneurysm rupture was compared.The factors associated with chronic hydrocephalus after two surgical methods were single factor.Analysis and Logistic regression analysis concluded that two surgical procedures were associated with chronic hydrocephalus.ResultsAccording to the above inclusion criteria and exclusion criteria and following the wishes of the patients or family members,408 cases were randomly divided into craniotomy group,130 males and 268 females,age 35~62 years,average age(52.37±6.49),154 cases in the intravascular interventional embolization group,44 men,110 women,age(55.46±8.37)years old.(1)the probability of chronic hydrocephalus in the craniotomy group was 14%(51/408,14%),and the probability of chronic hydrocephalus in the intravascular interventional embolization group was 26%(32/154,26%).The probability of chronic hydrocephalus in the intravascular interventional embolization group was significantly higher than that in the craniotomy group(?~2=6.088,P=0.014);(2)general data analysis showed that the two groups of patients with chronic hydrocephalus were associated with high grade Fisher classification and high grade Hunt-Hess classification,but the location of the aneurysm,the history of hypertension,and the size of the aneurysm were not related to them;(3)according to the single factor statistical analysis,it was found that the 4 factors of advanced age,high grade Hunt-Hess classification,hypertension history and high grade Fisher classification were statistically different from the occurrence of chronic hydrocephalus after craniotomy and interventional embolization(P<0.05),which were related factors and the location of the aneurysm and the occurrence of chronic hydrocephalus no correlation.Logistic regression analysis showed that the related factors of chronic hydrocephalus caused by craniotomy and interventional embolization of cerebral aneurysm were advanced,high grade Hunt-Hess classification and high grade Fisher classification.Conclusion(1)Craniotomy clipping and endovascular embolization may cause chronic hydrocephalus to some extent,but the incidence of chronic hydrocephalus in endovascular embolization is higher than that of craniotomy clipping.(2)Craniotomy clipping and endovascular embolization the occurrence of chronic hydrocephalus is related to advanced age,high grade Hunt-Hess classification and high grade Fisher classification. |
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