脑脊液分流在动脉瘤性蛛网膜下腔出血:我们应该多低?(S25.002)

文摘

目的:评估动脉瘤性蛛网膜下腔出血患者随机化的可行性(aSAH表示)和脑积水“积极”与“传统”脑脊液(CSF)排水。背景:外部心室下水道(evd格式)表示由于aSAH表示脑脊液引流对急性阻塞性脑积水。没有数据支持最优率或脑脊液引流时间。设计/方法:2,成人患者的前瞻性随机试验研究aSAH表示需要EVD急性脑积水。病人被随机分为:1)积极的脑脊液引流EVD开放5毫米汞柱,或2)常规CSF排水EVD开放15毫米汞柱。病人被随机分为EVD放置在24小时内。激进的手臂,EVD保持在5毫米汞柱7天直到断奶的审判可能尝试。EVD的患者在传统的手臂可以自由裁量权的断奶脑积水的临床治疗。按方案分析。结果:20例包括; 13 patients in the aggressive group. Median age was 54 years (IQR 47-72). Aneurysm was treated by endovascular coiling in 15 (75%) and by surgical clipping in 5 (25%). Twelve patients (60%) were poor clinical grade (WFNS grade IV-V) at nadir, and 4 patients (20%) remained poor-grade following CSF drainage. In the aggressive group, there was a trend towards more daily CSF output (median 220 cc vs 187 cc, p=0.09) and higher rate of ventriculoperitoneal shunt placement [n=10,( 77%) vs. 2 (29%), p=0.06). Duration of EVD placement was longer in the aggressive arm [median 11.5 days (IQR 7-15) vs. 8 days (8-15), p=0.53]. CONCLUSIONS: Randomizing aSAH patients with acute hydrocephalus to different degrees of CSF diversion is feasible. Results from this small pilot study suggest that a more aggressive approach to CSF diversion may be associated with higher rates of VP shunt placement, but this needs further investigation.

披露:Fugate博士没有披露。Rabinstein博士收到爱思唯尔和牛津的特许使用金。Rabinstein博士接到DJO全球研究支持。Wijdicks博士已经收到了个人在一篇社论中补偿Neurocritical护理的能力。Lanzino博士没有披露。