중증 뇌 지주막하 출혈 환자에서 수술전 뇌실 외부 배액술의 유용성
Effectiveness of Preoperative Extra-Ventricular Drainage in Poor Grade Aneurysmal Subarachnoid Hemorrhage
대한뇌혈관학회지 2002년 4권 1호 p.52 ~ 57
정종우, 조경기, 신용삼, 조기홍, 윤수한, 김혁준, 정영선,
소속 상세정보
정종우 ( Cheong Jong-Woo )
아주대학교 의과대학 신경외과학교실
조경기 ( Cho Kyung-Gi )
아주대학교 의과대학 신경외과학교실
신용삼 ( Shin Yong-Sam )
아주대학교 의과대학 신경외과학교실
조기홍 ( Cho Ki-Hong )
아주대학교 의과대학 신경외과학교실
윤수한 ( Yoon Soo-Han )
아주대학교 의과대학 신경외과학교실
김혁준 ( Kim Hyuk-Joon )
아주대학교 의과대학 신경외과학교실
정영선 ( Chung Young-Sun )
아주대학교 의과대학 신경외과학교실
KMID : 0890520020040010052
Abstract
Objective：Preoperative extra-ventricular drainage in poor grade aneurysmal subarachnoid hemorrhage (SAH) patients has been known to improve patient’s clinical grade. However, the risk of rebleeding due to increase of transmural pressure hinders its popular clinical use. The authors present new experience of preoperative extra-ventricular drainage in poor grade aneurysmal SAH.
Materials and Methods：From January 1996 to November 2001, 56 SAH patients underwent extra-ventricular drainage preoperatively. The mean age was 57.9 years (range 27 to 88). Hunt and Hess grade (HH grade) on the time of extra-ventricular drainage insertion were grade 3 in 4 patients, grade 4 in 35 patients and grade 5 in 17 patients. The overall clinical outcome of the patients who underwent extra-ventricular drainage and final clinical outcome according to the intervals between ventricular drainage and direct clipping/endovascular coiling were analysed retrospectively.
Result：Twenty-six patients (46.4%) improved clinically (average HH grade was improved from 4.6 to 3.3), 25 patients (44.6%) have not been changed, 5 patients (9%) aggravated (4 to 5) after ventricular drainage. Seven of 30 unchanged or aggravated patients underwent CT scan which revealed rebleeding of the aneurysm. 32 patients (57.1%) were treated with surgery or endovascular coiling. Seventeen patients (30.4%) have lost their opportunity of ultimate treatment because they had poor clinical course after extra-ventricular drainage. Final clinical outcome was not statistically different between early therapeutic group who underwent operation within 24 hours after extra-ventricular drainage and delayed therapeutic group who underwent operation after 24 hours. (Fisher extract test, survival rate P=0.603, clinical outcome P=1.000).
Conclusion：Preoperative extra-ventricular drainage had additional risk of rebleeding, however, it provides immediate improvement of patient’s neurological status and final clinical outcomes.
키워드
수술전 뇌실 외부 배액술
Extra-ventricular drainage;Aneurysmal subarachnoid hemorrhage;Rebleeding
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