关键词: 脑积水, 终板造瘘, 腰大池引流

Abstract:

Objective to evaluate the effect of Fisher grading endplate fistulation combined with lumbarcistern drainage on chronic hydrocephalus after aneurysm clipping. Methods According to the difference of opera⁃tion methods，205 patients with aSAH were divided into three groups：group A：22 patients with simple actionaneurysm clipping；group B：104 patients with endplate fistula during the operation of craniotomy clipping；groupC：79 patients with endplate fistula during the operation of craniotomy clipping，combined with lumbar cisterndrainage after the operation. Six months after SAH，the incidence of chronic hydrocephalus was compared amongthe three groups based on Fisher′s classification. The three groups were followed up for 12 months，and the survivalcurve was drawn by Kaplan⁃Meier survival analysis method，and the single factor survival analysis was conductedby log rank method. The prognosis of the patients was evaluated by modified Rankin Scale（mRS）. Results Theincidence of chronic hydrocephalus in group A，B and C was 33.33%，13.16% and 8.07%，respectively（P > 0.05）.The incidence of chronic hydrocephalus in group A，B and C was 38.46%，31.11% and 8.82%，respectively，withstatistical significance（P < 0.05）. The incidence of chronic hydrocephalus in three groups was statistically signifi⁃cant（P < 0.05），33.33% in group A，38.10% in group B and 9.09% in group C），The Bonferroni method wasfurther used to correct the test level，in which the difference between the groups B and C was statistically significant（χ2 = 8.679，P = 0.003）. Kaplan⁃Meier survival analysis method was used to draw the survival curve，and logrank method was used for single factor survival analysis. There was a significant difference in survival status amongthe three groups（P < 0.001）. After 12 months of follow⁃up，mRS scores of patients with Aash after aneurysmclipping showed that there was a significant difference in mRS scores between group A，group B and group Crespectively（P < 0.05），and there was no significant difference in mRS scores between group B and group CSignificance（P > 0.05）. Conclusion endplate fistulation combined with lumbar cistern drainage can not onlyreduce the incidence of chronic hydrocephalus in Fisher Ⅲ⁃Ⅳ grade aSAH patients

Key words: hydrocephalus, third ventriculostomy, lumbar drainage