Iwaasa Mitsutoshi, Ueba Tetsuya, Okawa Masakazu, Inoue Tooru
Department of Neurosurgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jounan-ku, Fukuoka City, Fukuoka, 814-0180, Japan.
Acta Neurochir Suppl. 2014;119:49-52. doi: 10.1007/978-3-319-02411-0_8.
Subarachnoid hemorrhage (SAH) with intraventricular hemorrhage (IVH) is associated with poor outcomes. The aim of this study was to evaluate the effectiveness of combined coiling and neuroendoscopy to treat severe SAH with massive IVH.
Between April 2008 and March 2012, 13 patients had massive IVH with a ruptured aneurysm treated at the Department of Neurosurgery, Fukuoka University, Japan. All 13 patients were treated within 2 days of onset by coiling and neuroendoscopic removal of the IVH, including the fourth ventricle.
No rebleeding or acute hydrocephalus were noted. Glasgow Outcome Scale scores (GOS) at discharge were: good recovery (two patients), moderate disability (three patients), severe disease (one patient), vegetative state (four patients), and dead (three patients). A good modified Rankin Scale score (mRS) (0-2) at 6 months was observed in six patients and a poor mRS score (3-6) occurred in seven. The pre- and post-operative Graeb scores were significantly lower in the good mRS group (p = 0.020 and 0.033, respectively, Mann-Whitney U-test). GOS scores at discharge were significantly associated with mRS score at 6 months (p = 0.011, Fisher's Exact Test).
Combined coiling and neuroendoscopic removal of the IVH, including the fourth ventricle, were feasible procedures and achieved preferable outcomes in approximately half of the cases.
蛛网膜下腔出血（SAH）合并脑室内出血（IVH）与不良预后相关。本研究的目的是评估联合血管内栓塞和神经内镜治疗严重SAH合并大量IVH的有效性。
2008年4月至2012年3月期间，日本福冈大学神经外科对13例患有破裂动脉瘤且伴有大量IVH的患者进行了治疗。所有13例患者均在发病2天内接受了血管内栓塞及神经内镜下清除包括第四脑室在内的IVH治疗。
未发现再出血或急性脑积水情况。出院时格拉斯哥预后量表（GOS）评分如下：恢复良好（2例）、中度残疾（3例）、重度疾病（1例）、植物状态（4例）和死亡（3例）。6个月时改良Rankin量表（mRS）评分为良好（0 - 2分）的有6例，评分为不良（3 - 6分）的有7例。良好mRS组术前和术后的Graeb评分显著更低（分别为p = 0.020和0.033，Mann-Whitney U检验）。出院时的GOS评分与6个月时的mRS评分显著相关（p = 0.011，Fisher精确检验）。
联合血管内栓塞和神经内镜清除包括第四脑室在内的IVH是可行的治疗方法，约半数病例取得了较好的治疗效果。
