Department of Neurosurgery, Affiliated People's Hospital of Jiangsu University, Jiangsu, China.
Department of Neurosurgery, Affiliated People's Hospital of Jiangsu University, Jiangsu, China.
World Neurosurg. 2022 Nov;167:e607-e613. doi: 10.1016/j.wneu.2022.08.056. Epub 2022 Aug 19.
To investigate combined external ventricular drainage and endoscope-assisted microsurgery using the middle frontal gyrus approach in patients with severe ventricular hemorrhage with casting of the fourth ventricle and patients' recovery after this treatment.
Patients with severe ventricular hemorrhage with casting of the fourth ventricle (n = 41) were randomly assigned to intervention and control groups. Modified Graeb score was used to assess 3-day hematoma clearance rate before and after surgery, drainage tube extubation time for the 2 groups was compared, and time when blood clot in the fourth ventricle was not blocked with cerebrospinal fluid was compared. Glasgow Coma Scale was used to assess consciousness after surgery; Glasgow Coma Scale scores recorded 1 and 7 days after surgery were also compared. Modified Rankin Scale was used to evaluate patients' recovery 1 and 6 months after surgery. Hydrocephalus and intracranial infections in patients after surgery were recorded for 90 days.
The 3-day hematoma clearance rate was dramatically higher in the intervention group. Modified Graeb score showed that more hemorrhage was delimited in 3 days in the intervention group. The intervention group exhibited significantly reduced length of block of the fourth ventricle and drainage tube extubation time. High Glasgow Coma Scale and modified Rankin Scale scores and significantly low incidence of complications (e.g., hydrocephalus and intracranial infection) were observed in patients in the intervention group.
Combined external ventricular drainage and endoscope-assisted microsurgery using the middle frontal gyrus approach can effectively improve severe ventricular hemorrhage with casting of the fourth ventricle and enhance patients' neurological function and recovery.
探讨联合应用外部脑室引流和内镜辅助经额中回入路微创手术治疗第四脑室铸型的重度脑室出血患者的效果及患者的恢复情况。
将 41 例第四脑室铸型的重度脑室出血患者随机分为干预组和对照组。采用改良 Graeb 评分评估手术前后 3 天血肿清除率，比较两组引流管拔管时间，比较两组第四脑室血肿块被脑脊液冲开的时间。术后采用格拉斯哥昏迷量表（GCS）评估意识，比较术后 1、7 天的 GCS 评分。术后 1、6 个月采用改良 Rankin 量表（mRS）评估患者的恢复情况。记录术后 90 天患者的脑积水和颅内感染情况。
干预组的 3 天血肿清除率明显较高。改良 Graeb 评分显示，干预组 3 天内的出血量更多。干预组第四脑室阻塞时间和引流管拔管时间明显缩短。干预组患者的格拉斯哥昏迷量表和改良 Rankin 量表评分较高，并发症（如脑积水和颅内感染）发生率较低。
联合应用外部脑室引流和内镜辅助经额中回入路微创手术可以有效治疗第四脑室铸型的重度脑室出血，提高患者的神经功能和恢复情况。
