蛛网膜下腔出血后脑积水的成因及治疗（附181例病例资料）
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摘要
自发性蛛网膜下腔出血(SAH)在普通人群中年发病率大约为8-10/10万人左右，占脑卒中的，发病率居脑血管意外的第3位，仅次于脑血栓形成和高血压脑出血存活者中三人之一留下中重度残废。它严重影响人类的生命安全及生活质量。本文通过收集大庆油田总医院神经外科自2008年9月至2011年9月我院手术及介入治疗181例自发性蛛网膜下腔出血（aSAH）病人的临床资料完整，其中包涵并发脑积水（急慢性）48份病例，并通过对其治疗结果及随访结果进行回顾性分析，综合分析了影响蛛网膜下腔出血(SA H)后脑积水的形成及治疗的各种因素。临床资料与方法：
1临床资料
1.1基本资料
2008年9月至2011年9月我院手术及介入治疗181例动脉瘤性蛛网膜下腔出血（aSAH），其中并发脑积水（急慢性）48例，本组48例，男22例，女26例，年龄18-78岁。
1.2既往史
既往有高血压病史者58例，冠心病病史者23例，二者兼有者5例，有头痛病史者7例，13名高龄患者合并腔隙性脑梗塞及脑萎缩，10名患者合并糖尿病。
1.3术前神经功能状态
入院H unt-Hess分级：I级3例，II级8例，III级19例，IV级18例。SAH次数：1次者36例，2次者10例，3次者2例。SAH次数：1次者36例，2次者10例，3次者2例。
2治疗方法
所有的患者在入院后根据病情轻重在６ｈ－１４ｄ内行手术或介入治疗，行翼点入路或改良翼点入路手术治疗动脉瘤患者２６例（所有责任动脉瘤均在显微手术下直视夹闭）。经介入栓塞治疗手术患者２２例（均在发病３ｄ内完成介入栓塞治疗，操作过程中无动脉瘤破裂）。
3治疗结果评价
出院时结果分为：1、良好；2、轻残；3、重残；4、死亡。在出院结果统计分析中，将良好和轻残定为预后良好，将重残和死亡归入预后不良。治疗后恢复良好者33例，轻残8例，重残7例，死亡0例。
4结论
（1）急性脑积水其发病机制一般认为是蛛网膜下腔和脑池、脑室内的血液影响了中脑导水管、Monro孔、基底池乃至是整个脑室系统和蛛网膜下腔的脑脊液循环,而导致脑脊液循环通路的梗阻。慢性脑积水主要是由于脑室内出血改变了脑脊液循环的动力学,并在后期引起比较严重的蛛网膜下腔内纤维化所致。
（2）脑积水的危险诱因包括性别（女性为多）、年龄、动脉的位置及大小，多发性动脉瘤；既往高血压病史和入院时血压增高，反复多次出血及出血后脑室积血，糖尿病，初次CT检查时脑室是否扩大,出血后的临床分级，吸烟、饮酒史等。
（3）随着患者Hunt-hess分级及Fisher分级的增高，引起急性脑积水的概率便随之增高。
（4）动脉瘤性蛛网膜下腔出血后脑积水的预防治疗首先应从起病时变应重视，将其预防治疗理念贯穿于整个治疗期间，通过保守治疗，预防性有创操作及手术治疗降低其发生率。
Object:
Based on hydrocephalus after aneurysmal subarachnoid hemorrhagestudied, to improve the cure rate of the patients.
Methods:
2008September to2011September in our hospital operation and interventi-onal treatment of181cases of subarachnoid hemorrhage (SAH), in whichconcurrent hydrocephalus (acute or chronic) in48cases,48cases of thisgroup,22were male,26female patients, age18-78years old.
All of the patients in the hospital according to the severity of the6h14dadept operation or interventional therapy, line the pterional approach orimproved pterional approach operation treatment of aneurysms in26cases (allaneurysms were in microsurgical operation of direct clipping). Percutaneousinterventional embolization for the treatment of22cases of patients withoperation (both in the pathogenesis of3D complete embolization, duringoperation without aneurysm rupture).
Result:
At discharge, good results are divided into:1good;2, with mild residual;3,severe disability,4death;. At discharge statistic analysis of results, will be goodand residual light for good prognosis, will severely disabled and deathattributed to poor prognosis.
After treatment,33cases had a good recovery,8cases of residual light,severe disability in7cases,0cases of death.
Conclusion:
Through this group of181patients retrospectively analysis, the followingconclusions can be drawn:
1. acute hydrocephalus and its pathogenesis is subarachnoid and cerebralpool, intraventricular blood affects midbrain aqueduct, Monro hole, basalcistern and even whole intraventricular and subarachnoid cerebrospinal fluidcirculation, leading to the circulation of the cerebrospinal fluid pathwayobstruction. Chronic hydrocephalus is mainly due to intraventricularhemorrhage changed circulation of cerebrospinal fluid dynamics, and in thelater lead to serious within the subarachnoid space fibrosis cause.
2. hydrocephalus risk factors include age, the position of the artery,anddiabetes mellitus, admission blood pressure increased, the initial CTexamination of ventricular enlargement and other relevant.
3. As patients with Hunt-hess classification and Fisher levels increased,causing acute hydrocephalus subsequently increased probability of change.
4. following aneurysmal subarachnoid hemorrhage hydrocephalusprevention treatment should first onset of allergic attention, its prevention andtreatment concept throughout the treatment period, the conservative treatment,prevention of invasive operation and operation treatment to reduce its incidence,improve the cure rate.
5. chronic hydrocephalus shunt in treatment choice for V-P, SAH afterapproximately2week after cerebrospinal fluid is basic and normal, some casesmay be asymptomatic, to observe, in children and the special physique, can beconsidered the lateral ventricle-sagittal sinus shunt for treatment ofhydrocephalus.
On hydrocephalus after subarachnoid hemorrhage prevention andtreatment, still some problems yet to be solved, we also need to work in the future to further research and discussion.
1临床资料
1.1基本资料
2008年9月至2011年9月我院手术及介入治疗181例动脉瘤性蛛网膜下腔出血（aSAH），其中并发脑积水（急慢性）48例，本组48例，男22例，女26例，年龄18-78岁。
1.2既往史
既往有高血压病史者58例，冠心病病史者23例，二者兼有者5例，有头痛病史者7例，13名高龄患者合并腔隙性脑梗塞及脑萎缩，10名患者合并糖尿病。
1.3术前神经功能状态
入院H unt-Hess分级：I级3例，II级8例，III级19例，IV级18例。SAH次数：1次者36例，2次者10例，3次者2例。SAH次数：1次者36例，2次者10例，3次者2例。
2治疗方法
所有的患者在入院后根据病情轻重在６ｈ－１４ｄ内行手术或介入治疗，行翼点入路或改良翼点入路手术治疗动脉瘤患者２６例（所有责任动脉瘤均在显微手术下直视夹闭）。经介入栓塞治疗手术患者２２例（均在发病３ｄ内完成介入栓塞治疗，操作过程中无动脉瘤破裂）。
3治疗结果评价
出院时结果分为：1、良好；2、轻残；3、重残；4、死亡。在出院结果统计分析中，将良好和轻残定为预后良好，将重残和死亡归入预后不良。治疗后恢复良好者33例，轻残8例，重残7例，死亡0例。
4结论
（1）急性脑积水其发病机制一般认为是蛛网膜下腔和脑池、脑室内的血液影响了中脑导水管、Monro孔、基底池乃至是整个脑室系统和蛛网膜下腔的脑脊液循环,而导致脑脊液循环通路的梗阻。慢性脑积水主要是由于脑室内出血改变了脑脊液循环的动力学,并在后期引起比较严重的蛛网膜下腔内纤维化所致。
（2）脑积水的危险诱因包括性别（女性为多）、年龄、动脉的位置及大小，多发性动脉瘤；既往高血压病史和入院时血压增高，反复多次出血及出血后脑室积血，糖尿病，初次CT检查时脑室是否扩大,出血后的临床分级，吸烟、饮酒史等。
（3）随着患者Hunt-hess分级及Fisher分级的增高，引起急性脑积水的概率便随之增高。
（4）动脉瘤性蛛网膜下腔出血后脑积水的预防治疗首先应从起病时变应重视，将其预防治疗理念贯穿于整个治疗期间，通过保守治疗，预防性有创操作及手术治疗降低其发生率。
Object:
Based on hydrocephalus after aneurysmal subarachnoid hemorrhagestudied, to improve the cure rate of the patients.
Methods:
2008September to2011September in our hospital operation and interventi-onal treatment of181cases of subarachnoid hemorrhage (SAH), in whichconcurrent hydrocephalus (acute or chronic) in48cases,48cases of thisgroup,22were male,26female patients, age18-78years old.
All of the patients in the hospital according to the severity of the6h14dadept operation or interventional therapy, line the pterional approach orimproved pterional approach operation treatment of aneurysms in26cases (allaneurysms were in microsurgical operation of direct clipping). Percutaneousinterventional embolization for the treatment of22cases of patients withoperation (both in the pathogenesis of3D complete embolization, duringoperation without aneurysm rupture).
Result:
At discharge, good results are divided into:1good;2, with mild residual;3,severe disability,4death;. At discharge statistic analysis of results, will be goodand residual light for good prognosis, will severely disabled and deathattributed to poor prognosis.
After treatment,33cases had a good recovery,8cases of residual light,severe disability in7cases,0cases of death.
Conclusion:
Through this group of181patients retrospectively analysis, the followingconclusions can be drawn:
1. acute hydrocephalus and its pathogenesis is subarachnoid and cerebralpool, intraventricular blood affects midbrain aqueduct, Monro hole, basalcistern and even whole intraventricular and subarachnoid cerebrospinal fluidcirculation, leading to the circulation of the cerebrospinal fluid pathwayobstruction. Chronic hydrocephalus is mainly due to intraventricularhemorrhage changed circulation of cerebrospinal fluid dynamics, and in thelater lead to serious within the subarachnoid space fibrosis cause.
2. hydrocephalus risk factors include age, the position of the artery,anddiabetes mellitus, admission blood pressure increased, the initial CTexamination of ventricular enlargement and other relevant.
3. As patients with Hunt-hess classification and Fisher levels increased,causing acute hydrocephalus subsequently increased probability of change.
4. following aneurysmal subarachnoid hemorrhage hydrocephalusprevention treatment should first onset of allergic attention, its prevention andtreatment concept throughout the treatment period, the conservative treatment,prevention of invasive operation and operation treatment to reduce its incidence,improve the cure rate.
5. chronic hydrocephalus shunt in treatment choice for V-P, SAH afterapproximately2week after cerebrospinal fluid is basic and normal, some casesmay be asymptomatic, to observe, in children and the special physique, can beconsidered the lateral ventricle-sagittal sinus shunt for treatment ofhydrocephalus.
On hydrocephalus after subarachnoid hemorrhage prevention andtreatment, still some problems yet to be solved, we also need to work in the future to further research and discussion.
引文
[1] Greenberg. SAH and aneurysms. Handbook of Neurosurery,5th,Edn.NewYork:Thieme Medical2000;754-803.
[2] Hop JW, Rinkel GJE, Algra A, van Gijn J. Case-Fatality Rates andFunctional Outcome After Subarachnoid Hemorrhage: A SystematicReview. Stroke1997;28(3):660-664.
[3] Johnston SC, Selvin S, Gress DR. The burden, trends, and demographics ofmortality from subarachnoid hemorrhage. Neurology1998;50(5):1413-1418.
[4] Pietil TA, Heimberger KC, Palleske H, Brock M. Influence of aneurysmlocation on the development of chronic hydrocephalus following SAH. ActaNeurochirurgica1995;137(1-2):70-73.
[5] Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm tosubarachnoid hemorrhage visualized by computerized tomographicscanning. Neurosurgery1980;6(1):1-9.
[6]周良辅.现代神经外科学[M]上海：复旦大学出版社；上海医科大学出版社。2001.
[7] Vale FL, Bradley EL, Fisher WS. The relationship of subarachnoidhemorrhage and the need for postoperative shunting. J Neurosurg1997;86(3):462-466.
[8] Otawara Y, Ogasawara K, Ogawa A, Sasaki M, Takahashi K. Evaluation ofVasospasm after Subarachnoid Hemorrhage by Use of Multislice ComputedTomographic Angiography. Neurosurgery2002;51(4):939-943.
[9] McDonald CT, Carter BS, Putman C, et al.Subarachnoid HemorrhageTreatment&Management CardiovascMed,2001,3:429-439.
[10]Brisman JL, Berenstein A. Factors Related to Hydrocephalus afterAneurysmal Subarachnoid Hemorrhage. Neurosurgery2004;54(4):103110.1227/01.NEU.0000117123.32806.F9.
[11]Suarez-Rivera M.D O. Acute Hydrocephalus After SubarachnoidHemorrhage. Surgical Neurology1998;49(5):563-565.
[12]季楠,赵继宗.动脉瘤性蛛网膜下腔出血后慢性脑积水易患因素分析.北京医学2003;25(3):4.
[13]Ishii MM.[Subarachnoid hemorrhage and circulatory disturbance ofcerebrospinal fluid--scanning electron microscopid study in clinical andautopsy cases (author's transl)] No Shinkei Geka1979;7(6):579-588.
[14]Moinuddin SM, Tada T. Study of cerebrospinal fluid flow dynamics inTGF-beta1induced chronic hydrocephalic mice. Neurol Res2000;22(2):215-222.
[15]Kitazawa K, Tada T. Elevation of transforming growth factor-beta1levelin cerebrospinal fluid of patients with communicating hydrocephalus aftersubarachnoid hemorrhage. Stroke1994;25(7):1400-1404.
[16]何福亮,张鸿祺,李萌, et al.影响重症动脉瘤性蛛网膜下腔出血预后因素的分析.中国脑血管病杂志2010;07(8).
[17]顾奇芳,冯东侠,张田旺, et al.动脉瘤破裂出血并发急性脑积水32例临床报告.中国医师杂志2004;6(5):1.
[18]吴晓辉,陈劲草,王胜.动脉瘤性蛛网膜下腔出血不同时期脑积水的诊治.中国临床神经外科杂志2010;15(8).
[19]Hoekema D, Schmidt R, Ross I. Lumbar drainage for subarachnoidhemorrhage: technical considerations and safety analysis. NeurocriticalCare2007;7(1):3-9.
[20]Ruijs ACJ, Dirven CMF, Algra A, Beijer I, Vandertop WP, Rinkel G. Therisk of rebleeding after external lumbar drainage in patients with untreatedruptured cerebral aneurysms. Acta Neurochirurgica2005;147(11):1157-1162.
[21]Ochiai H, Yamakawa Y. Continuous lumbar drainage for the preoperativemanagement of patients with aneurysmal subarachnoid hemorrhage. NeurolMed Chir (Tokyo)2001;41(12):576-581.
[22]Rammos S, Klopfenstein J, Augsburger L, et al. Conversion of externalventricular drains to ventriculoperitoneal shunts after aneurysmal subara-chnoid hemorrhage: effects of site and protein/red blood cell counts onshunt infection and malfunction. Journal of Neurosurgery2008;109(6):1001-1004.
[23]Ohwaki K, Yano E, Nakagomi T, Tamura A. Relationship betweenshunt-dependent hydrocephalus after subarachnoid haemorrhage andduration of cerebrospinal fluid drainage. British Journal of Neurosurgery2004;18(2):130-134.
[24]Zabramski JM, Whiting D, Darouiche RO, et al. Efficacy of antimicrobial-impregnated external ventricular drain catheters: a prospective, randomized,controlled trial. Journal of Neurosurgery2003;98(4):725-730.
[25]Fichtner J, Güresir E, Seifert V, Raabe A. Efficacy of silver-bearingexternal ventricular drainage catheters: a retrospective analysis. Journal ofNeurosurgery2010;112(4):840-846.
[26]Schürk mper M, Medele R, Zausinger S, Schmid-Elsaesser R, Steiger H-J.Dexamethasone in the treatment of subarachnoid hemorrhage revisited: acomparative analysis of the effect of the total dose on complications andoutcome. Journal of Clinical Neuroscience2004;11(1):20-24.
[27]Suarez JI, Shannon L, Zaidat OO, et al. Effect of human albuminadministration on clinical outcome and hospital cost in patients withsubarachnoid hemorrhage. Journal of Neurosurgery2004;100(4):585-590.
[28]闻林,林亮楠,邹宇辉,陈宁,古林静.腰大池置管控制引流速度治疗自发性蛛网膜下腔出血.南方医科大学学报2007;27(2):2.
[29]Komotar RJ, Olivi A, Rigamonti D, Tamargo RJ. Microsurgicalfenestration of the lamina terminalis reduces the incidence of shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage.Neurosurgery2002;51(6):1403-1403.
[30]Tomasello F, d'Avella D, de Divitiis O. Does Lamina TerminalisFenestration Reduce the Incidence of Chronic Hydrocephalus afterSubarachnoid Hemorrhage? Neurosurgery1999;45(4):827.
[31]Dorai Z, Hynan LS, Kopitnik TA, Samson D. Factors Related toHydrocephalus after Aneurysmal Subarachnoid Hemorrhage. Neurosurgery2003;52(4):763-77110.1227/01.NEU.0000053222.74852.2D.
[32]Heinsoo M, Eelm e J, Kuklane M, Tomberg T, Tikk A, Asser T. Thepossible role of CSF hydrodynamic parameters following in management ofSAH patients. Acta Neurochir Suppl1998;71:13-15.
[33]李铁林,刘亚杰.蛛网膜下腔出血患者诊断与治疗中应注意的若干问题.中华医学杂志2003;83(1):3.
[34]Hirashima Y, Hamada H, Hayashi N, Kuwayama N, Origasa H, Endo S.Independent predictors of late hydrocephalus in patients with aneurysmalsubarachnoid hemorrhage--analysis by multivariate logistic regressionmodel. Cerebrovasc Dis2003;16(3):205-210.
[35]Johnston JM, Chicoine MR, Dacey RG, Zipfel GJ. AneurysmalSubarachnoid Hemorrhage, Hydrocephalus, and Acute Paraparesis. Neuro-surgery2008;63(6):1119-112410.1227/01. NEU.0000334428.21007.2D.
[36]宋锦宁,刘守勋,鲍刚, et al.动脉瘤性蛛网膜下腔出血后脑积水的临床特点及诊治.中国现代医学杂志2007;17(7):4.
[37]梁君,栾凤岩,刘云会.侧脑室-矢状窦分流术治疗脑积水42例临床体会.中国微侵袭神经外科杂志2005;10(6):1.
[1]Linn FH, Rinkel GJ, Algra A, van Gijn J. Headache characteristics insubarachnoid haemorrhage and benign thunderclap headache. J NeurolNeurosurg Psychiatry1998;65(5):791-793.
[2] Hop JW, Rinkel GJE, Algra A, van Gijn J. Case-Fatality Rates andFunctional Outcome After Subarachnoid Hemorrhage: A SystematicReview. Stroke1997;28(3):660-664.
[3] Saliou G, Balédent O, Lehmann P, et al. Caractérisation des perturbationsdu flux de LCS dans l’aqueduc du mésencéphale par IRM–CP à la phaseaigu de l’hémorragie méningée. J Neuroradiol2009;36(1):41-47.
[4] Douglas MR, Daniel M, Lagord C, et al. High CSF transforming growthfactor β levels after subarachnoid haemorrhage: association with chroniccommunicating hydrocephalus. Journal of Neurology, Neurosurgery&Psychiatry2009;80(5):545-550.
[5] Suzuki H, Muramatsu M, Tanaka K, Fujiwara H, Kojima T, Taki W.Cerebrospinal fluid ferritin in chronic hydrocephalus after aneurysmalsubarachnoid hemorrhage. Journal of Neurology2006;253(9):1170-1176.
[6] Isu T, Sasaki H, Takamura H, Kobayashi N. Foramen MagnumDecompression with Removal of the Outer Layer of the Dura as Treatmentfor Syringomyelia Occurring with Chiari I Malformation. Neurosurgery1993;33(5):845-850.
[7] Depreitere B, Van Calenbergh F, van Loon J, Goffin J, Plets C. Posteriorfossa decompression in syringomyelia associated with a Chiarimalformation: a retrospective analysis of22patients. Clinical Neurologyand Neurosurgery2000;102(2):91-96.
[8] Vale FL, Bradley EL, Fisher WS. The relationship of subarachnoidhemorrhage and the need for postoperative shunting. Journal of Neuro-surgery1997;86(3):462-466.
[9] Sheehan JP, Polin RS, Sheehan JM, Baskaya MK, Kassell NF, Participantsa. Factors Associated with Hydrocephalus after Aneurysmal SubarachnoidHemorrhage. Neurosurgery1999;45(5):1120.
[10]Yoshioka H, Inagawa T, Tokuda Y, Inokuchi F. Chronic hydrocephalus inelderly patients following subarachnoid hemorrhage. Surgical Neurology2000;53(2):119-125.
[11]刘承基主编．脑血管外科学[M]．南京：江苏科学技术出版社，2000．9-10
[12]J. A. HUTCHINSON H. M. SEELEY P. J. KIRKPATRICK P. Factorsimplicated in deaths from subarachnoid haemorrhage: are they avoidable?British Journal of Neurosurgery1998;12(1):37-40.
[13]Gruber A, Reinprecht A, Bavinzski G, Czech T, Richling B. ChronicShunt-dependent Hydrocephalus after Early Surgical and Early Endova-scular Treatment of Ruptured Intracranial Aneurysms. Neurosurgery1999;44(3):503-509.
[14]Sajanti J, Heikkinen E, Majamaa K. Transient increase in procollagenpropeptides in the CSF after subarachnoid hemorrhage. Neurology2000;55(3):359-363.
[15]Moinuddin SM, Tada T. Study of cerebrospinal fluid flow dynamics inTGF-beta1induced chronic hydrocephalic mice. Neurol Res2000;22(2):215-222.
[16]Ogungbo B, Gregson BA, Blackburn A, Mendelow AD, NewcastleSubarachnoid Study G. Trends over time in the management ofsubarachnoid haemorrhage in newcastle: review of1609patients. Br JNeurosurg2001;15(5):388-395.
[17]Klekamp J, Batzdorf U, Samii M, Bothe HW. The surgical treatment ofChiari I malformation. Acta Neurochir (Wien)1996;138(7):788-801.
[18]Haroun RI, Guarnieri M, Meadow JJ, Kraut M, Carson BS. Currentopinions for the treatment of syringomyelia and chiari malformations:survey of the Pediatric Section of the American Association of NeurologicalSurgeons. Pediatr Neurosurg2000;33(6):311-317.
[19]Goel A, Desai K. Surgery for Syringomyelia: An Analysis Based on163Surgical Cases. Acta Neurochirurgica2000;142(3):293-302.
[20]Widenka DC, Wolf S, Schürer L, Plev DV, Lumenta CB. Factors leading tohydrocephalus after aneurysmal subarachnoid hemorrhage. NeurolNeurochir Pol2000;34(6Suppl):56-60.
[21]Badie B, Mendoza D, Batzdorf U. Posterior Fossa Volume and Response toSuboccipital Decompression in Patients with Chiari I Malformation.Neurosurgery1995;37(2):214-218.
[22]Pietil T, Heimberger K, Palleske H, Brock M. Influence of aneurysmlocation on the development of chronic hydrocephalus following SAH. ActaNeurochirurgica1995;137(1):70-73.
[23]van Gijn J, Rinkel GJE. Subarachnoid haemorrhage: diagnosis, causes andmanagement. Brain2001;124(2):249-278.
[24]McDonald CT， Carter BS， Putman C， et a1． Subarachnoid hemo-rrhage．CurtTreatOptions CardiovascMed，2OO1，3：429-439．
[25]Heinsoo M, Eelm e J, Kuklane M, Tomberg T, Tikk A, Asser T. Thepossible role of CSF hydrodynamic parameters following in management ofSAH patients. Acta Neurochir Suppl1998;71:13-15.
[26]周良辅.现代神经外科学[M]上海：复旦大学出版社；上海医科大学出版社。2001.
[27]Dorai Z, Hynan LS, Kopitnik TA, Samson D. Factors Related toHydrocephalus after Aneurysmal Subarachnoid Hemorrhage. Neurosurgery2003;52(4):763-771.
[28]Kasuya H, Shimizu T, Kagawa M. The effect of continuous drainage ofcerebrospinal fluid in patients with subarachnoid hemorrhage: aretrospective analysis of108patients. Neurosurgery1991;28(1):56-9.
[29]Paré L, Delfino R, Leblanc R. The relationship of ventricular drainage toaneurysmal rebleeding. Journal of Neurosurgery1992;76(3):422-427.
[30]Jartti P, Karttunen A, Jartti A, Ukkola V, Sajanti J, Pyhtinen J. FactorsRelated to Acute Hydrocephalus After Subarachnoid Hemorrhage. ActaRadiologica2004;45(3):333-339.
[31]杭春华,史继新,谭启富,孙克华,邬祖良,王汉东.动脉瘤性蛛网膜下腔出血后脑积水.中华神经外科杂志2001;17(6):3.
[32]魏爱华,刘胜,陈惠芳.脑室引流术后并发脑室感染的原因及防治.中华医院感染学杂志2002;12(9):2.
[33]许刚,张帆,陈谦学.颅脑术后并发颅内感染的高危因素分析.中国临床神经外科杂志2008;13(6):3.
[34]陈风华,刘劲芳,方加胜, et al.脑室-腹腔分流术并发症的防治.中华神经外科疾病研究杂志2006;5(3):2.
[35]成秋生,潘小平.脑室外引流术29例并发症原因分析.广东医学2003;24(6):2.
[36]Passero S, Ulivelli M, Reale F. Primary intraventricular haemorrhage inadults. Acta Neurologica Scandinavica2002;105(2):115-119.
[37]Hellingman CA, van den Bergh WM, Beijer IS, et al. Risk of RebleedingAfter Treatment of Acute Hydrocephalus in Patients With AneurysmalSubarachnoid Hemorrhage. Stroke2007;38(1):96-99.
[38]Liliang P-C, Liang C-L, Lu C-H, et al. Hypertensive Caudate HemorrhagePrognostic Predictor, Outcome, and Role of External Ventricular Drainage.Stroke2001;32(5):1195-1200.
[39]Gjerris F, B rgesen SE, S rensen PS, et al. Resistance to cerebrospinalfluid outflow and intracranial pressure in patients with hydrocephales aftersubarachnoid haemorrhage. Acta Neurochirurgica1987;88(3):79-86.
[40]Pluta RM, Hansen-Schwartz J, Dreier J, et al. Cerebral vasospasmfollowing subarachnoid hemorrhage: time for a new world of thought.Neurol Res2009;31(2):151-158.
[41]宋仁兴,赵奇煌,杨新乾,吴卫.持续腰大池引流在颅内动脉瘤术后的临床应用价值.中国医药导刊2005;7(2):3.
[42]宋奎勤,李新钢.持续腰大池引流在神经外科的临床应用(附220例分析).中国临床神经外科杂志2008;13(1):1.
[43]刘春霖,李卫,曾山.颅内压控制下持续腰大池引流治疗外伤性蛛网膜下腔出血.中华神经医学杂志2004;3(4):3.
[44]Ohwaki K, Yano E, Nakagomi T, Tamura A. Relationship betweenshunt-dependent hydrocephalus after subarachnoid haemorrhage andduration of cerebrospinal fluid drainage. British Journal of Neurosurgery2004;18(2):130-134.
[45]黄如训,施晓耕.蛛网膜下腔出血的重症监护.内科急危重症杂志2003;9(4):4.
[46]Komotar RJ, Olivi A, Rigamonti D, Tamargo RJ. MicrosurgicalFenestration of the Lamina Terminalis Reduces the Incidence of Shunt-dependent Hydrocephalus after Aneurysmal Subarachnoid Hemo-rrhage.Neurosurgery2002;51(6):1403-141310.1227/01. NEU.0000309116.09463.A6.
[47]季楠,赵继宗.动脉瘤性蛛网膜下腔出血后慢性脑积水易患因素分析.北京医学2003;25(3):4.
[48]李金星,朱贤立,赵甲山.动脉瘤性蛛网膜下腔出血后慢性脑积水的研究进展.国外医学(神经病学神经外科学分册)2004;31(2):4.
[2] Hop JW, Rinkel GJE, Algra A, van Gijn J. Case-Fatality Rates andFunctional Outcome After Subarachnoid Hemorrhage: A SystematicReview. Stroke1997;28(3):660-664.
[3] Johnston SC, Selvin S, Gress DR. The burden, trends, and demographics ofmortality from subarachnoid hemorrhage. Neurology1998;50(5):1413-1418.
[4] Pietil TA, Heimberger KC, Palleske H, Brock M. Influence of aneurysmlocation on the development of chronic hydrocephalus following SAH. ActaNeurochirurgica1995;137(1-2):70-73.
[5] Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm tosubarachnoid hemorrhage visualized by computerized tomographicscanning. Neurosurgery1980;6(1):1-9.
[6]周良辅.现代神经外科学[M]上海：复旦大学出版社；上海医科大学出版社。2001.
[7] Vale FL, Bradley EL, Fisher WS. The relationship of subarachnoidhemorrhage and the need for postoperative shunting. J Neurosurg1997;86(3):462-466.
[8] Otawara Y, Ogasawara K, Ogawa A, Sasaki M, Takahashi K. Evaluation ofVasospasm after Subarachnoid Hemorrhage by Use of Multislice ComputedTomographic Angiography. Neurosurgery2002;51(4):939-943.
[9] McDonald CT, Carter BS, Putman C, et al.Subarachnoid HemorrhageTreatment&Management CardiovascMed,2001,3:429-439.
[10]Brisman JL, Berenstein A. Factors Related to Hydrocephalus afterAneurysmal Subarachnoid Hemorrhage. Neurosurgery2004;54(4):103110.1227/01.NEU.0000117123.32806.F9.
[11]Suarez-Rivera M.D O. Acute Hydrocephalus After SubarachnoidHemorrhage. Surgical Neurology1998;49(5):563-565.
[12]季楠,赵继宗.动脉瘤性蛛网膜下腔出血后慢性脑积水易患因素分析.北京医学2003;25(3):4.
[13]Ishii MM.[Subarachnoid hemorrhage and circulatory disturbance ofcerebrospinal fluid--scanning electron microscopid study in clinical andautopsy cases (author's transl)] No Shinkei Geka1979;7(6):579-588.
[14]Moinuddin SM, Tada T. Study of cerebrospinal fluid flow dynamics inTGF-beta1induced chronic hydrocephalic mice. Neurol Res2000;22(2):215-222.
[15]Kitazawa K, Tada T. Elevation of transforming growth factor-beta1levelin cerebrospinal fluid of patients with communicating hydrocephalus aftersubarachnoid hemorrhage. Stroke1994;25(7):1400-1404.
[16]何福亮,张鸿祺,李萌, et al.影响重症动脉瘤性蛛网膜下腔出血预后因素的分析.中国脑血管病杂志2010;07(8).
[17]顾奇芳,冯东侠,张田旺, et al.动脉瘤破裂出血并发急性脑积水32例临床报告.中国医师杂志2004;6(5):1.
[18]吴晓辉,陈劲草,王胜.动脉瘤性蛛网膜下腔出血不同时期脑积水的诊治.中国临床神经外科杂志2010;15(8).
[19]Hoekema D, Schmidt R, Ross I. Lumbar drainage for subarachnoidhemorrhage: technical considerations and safety analysis. NeurocriticalCare2007;7(1):3-9.
[20]Ruijs ACJ, Dirven CMF, Algra A, Beijer I, Vandertop WP, Rinkel G. Therisk of rebleeding after external lumbar drainage in patients with untreatedruptured cerebral aneurysms. Acta Neurochirurgica2005;147(11):1157-1162.
[21]Ochiai H, Yamakawa Y. Continuous lumbar drainage for the preoperativemanagement of patients with aneurysmal subarachnoid hemorrhage. NeurolMed Chir (Tokyo)2001;41(12):576-581.
[22]Rammos S, Klopfenstein J, Augsburger L, et al. Conversion of externalventricular drains to ventriculoperitoneal shunts after aneurysmal subara-chnoid hemorrhage: effects of site and protein/red blood cell counts onshunt infection and malfunction. Journal of Neurosurgery2008;109(6):1001-1004.
[23]Ohwaki K, Yano E, Nakagomi T, Tamura A. Relationship betweenshunt-dependent hydrocephalus after subarachnoid haemorrhage andduration of cerebrospinal fluid drainage. British Journal of Neurosurgery2004;18(2):130-134.
[24]Zabramski JM, Whiting D, Darouiche RO, et al. Efficacy of antimicrobial-impregnated external ventricular drain catheters: a prospective, randomized,controlled trial. Journal of Neurosurgery2003;98(4):725-730.
[25]Fichtner J, Güresir E, Seifert V, Raabe A. Efficacy of silver-bearingexternal ventricular drainage catheters: a retrospective analysis. Journal ofNeurosurgery2010;112(4):840-846.
[26]Schürk mper M, Medele R, Zausinger S, Schmid-Elsaesser R, Steiger H-J.Dexamethasone in the treatment of subarachnoid hemorrhage revisited: acomparative analysis of the effect of the total dose on complications andoutcome. Journal of Clinical Neuroscience2004;11(1):20-24.
[27]Suarez JI, Shannon L, Zaidat OO, et al. Effect of human albuminadministration on clinical outcome and hospital cost in patients withsubarachnoid hemorrhage. Journal of Neurosurgery2004;100(4):585-590.
[28]闻林,林亮楠,邹宇辉,陈宁,古林静.腰大池置管控制引流速度治疗自发性蛛网膜下腔出血.南方医科大学学报2007;27(2):2.
[29]Komotar RJ, Olivi A, Rigamonti D, Tamargo RJ. Microsurgicalfenestration of the lamina terminalis reduces the incidence of shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage.Neurosurgery2002;51(6):1403-1403.
[30]Tomasello F, d'Avella D, de Divitiis O. Does Lamina TerminalisFenestration Reduce the Incidence of Chronic Hydrocephalus afterSubarachnoid Hemorrhage? Neurosurgery1999;45(4):827.
[31]Dorai Z, Hynan LS, Kopitnik TA, Samson D. Factors Related toHydrocephalus after Aneurysmal Subarachnoid Hemorrhage. Neurosurgery2003;52(4):763-77110.1227/01.NEU.0000053222.74852.2D.
[32]Heinsoo M, Eelm e J, Kuklane M, Tomberg T, Tikk A, Asser T. Thepossible role of CSF hydrodynamic parameters following in management ofSAH patients. Acta Neurochir Suppl1998;71:13-15.
[33]李铁林,刘亚杰.蛛网膜下腔出血患者诊断与治疗中应注意的若干问题.中华医学杂志2003;83(1):3.
[34]Hirashima Y, Hamada H, Hayashi N, Kuwayama N, Origasa H, Endo S.Independent predictors of late hydrocephalus in patients with aneurysmalsubarachnoid hemorrhage--analysis by multivariate logistic regressionmodel. Cerebrovasc Dis2003;16(3):205-210.
[35]Johnston JM, Chicoine MR, Dacey RG, Zipfel GJ. AneurysmalSubarachnoid Hemorrhage, Hydrocephalus, and Acute Paraparesis. Neuro-surgery2008;63(6):1119-112410.1227/01. NEU.0000334428.21007.2D.
[36]宋锦宁,刘守勋,鲍刚, et al.动脉瘤性蛛网膜下腔出血后脑积水的临床特点及诊治.中国现代医学杂志2007;17(7):4.
[37]梁君,栾凤岩,刘云会.侧脑室-矢状窦分流术治疗脑积水42例临床体会.中国微侵袭神经外科杂志2005;10(6):1.
[1]Linn FH, Rinkel GJ, Algra A, van Gijn J. Headache characteristics insubarachnoid haemorrhage and benign thunderclap headache. J NeurolNeurosurg Psychiatry1998;65(5):791-793.
[2] Hop JW, Rinkel GJE, Algra A, van Gijn J. Case-Fatality Rates andFunctional Outcome After Subarachnoid Hemorrhage: A SystematicReview. Stroke1997;28(3):660-664.
[3] Saliou G, Balédent O, Lehmann P, et al. Caractérisation des perturbationsdu flux de LCS dans l’aqueduc du mésencéphale par IRM–CP à la phaseaigu de l’hémorragie méningée. J Neuroradiol2009;36(1):41-47.
[4] Douglas MR, Daniel M, Lagord C, et al. High CSF transforming growthfactor β levels after subarachnoid haemorrhage: association with chroniccommunicating hydrocephalus. Journal of Neurology, Neurosurgery&Psychiatry2009;80(5):545-550.
[5] Suzuki H, Muramatsu M, Tanaka K, Fujiwara H, Kojima T, Taki W.Cerebrospinal fluid ferritin in chronic hydrocephalus after aneurysmalsubarachnoid hemorrhage. Journal of Neurology2006;253(9):1170-1176.
[6] Isu T, Sasaki H, Takamura H, Kobayashi N. Foramen MagnumDecompression with Removal of the Outer Layer of the Dura as Treatmentfor Syringomyelia Occurring with Chiari I Malformation. Neurosurgery1993;33(5):845-850.
[7] Depreitere B, Van Calenbergh F, van Loon J, Goffin J, Plets C. Posteriorfossa decompression in syringomyelia associated with a Chiarimalformation: a retrospective analysis of22patients. Clinical Neurologyand Neurosurgery2000;102(2):91-96.
[8] Vale FL, Bradley EL, Fisher WS. The relationship of subarachnoidhemorrhage and the need for postoperative shunting. Journal of Neuro-surgery1997;86(3):462-466.
[9] Sheehan JP, Polin RS, Sheehan JM, Baskaya MK, Kassell NF, Participantsa. Factors Associated with Hydrocephalus after Aneurysmal SubarachnoidHemorrhage. Neurosurgery1999;45(5):1120.
[10]Yoshioka H, Inagawa T, Tokuda Y, Inokuchi F. Chronic hydrocephalus inelderly patients following subarachnoid hemorrhage. Surgical Neurology2000;53(2):119-125.
[11]刘承基主编．脑血管外科学[M]．南京：江苏科学技术出版社，2000．9-10
[12]J. A. HUTCHINSON H. M. SEELEY P. J. KIRKPATRICK P. Factorsimplicated in deaths from subarachnoid haemorrhage: are they avoidable?British Journal of Neurosurgery1998;12(1):37-40.
[13]Gruber A, Reinprecht A, Bavinzski G, Czech T, Richling B. ChronicShunt-dependent Hydrocephalus after Early Surgical and Early Endova-scular Treatment of Ruptured Intracranial Aneurysms. Neurosurgery1999;44(3):503-509.
[14]Sajanti J, Heikkinen E, Majamaa K. Transient increase in procollagenpropeptides in the CSF after subarachnoid hemorrhage. Neurology2000;55(3):359-363.
[15]Moinuddin SM, Tada T. Study of cerebrospinal fluid flow dynamics inTGF-beta1induced chronic hydrocephalic mice. Neurol Res2000;22(2):215-222.
[16]Ogungbo B, Gregson BA, Blackburn A, Mendelow AD, NewcastleSubarachnoid Study G. Trends over time in the management ofsubarachnoid haemorrhage in newcastle: review of1609patients. Br JNeurosurg2001;15(5):388-395.
[17]Klekamp J, Batzdorf U, Samii M, Bothe HW. The surgical treatment ofChiari I malformation. Acta Neurochir (Wien)1996;138(7):788-801.
[18]Haroun RI, Guarnieri M, Meadow JJ, Kraut M, Carson BS. Currentopinions for the treatment of syringomyelia and chiari malformations:survey of the Pediatric Section of the American Association of NeurologicalSurgeons. Pediatr Neurosurg2000;33(6):311-317.
[19]Goel A, Desai K. Surgery for Syringomyelia: An Analysis Based on163Surgical Cases. Acta Neurochirurgica2000;142(3):293-302.
[20]Widenka DC, Wolf S, Schürer L, Plev DV, Lumenta CB. Factors leading tohydrocephalus after aneurysmal subarachnoid hemorrhage. NeurolNeurochir Pol2000;34(6Suppl):56-60.
[21]Badie B, Mendoza D, Batzdorf U. Posterior Fossa Volume and Response toSuboccipital Decompression in Patients with Chiari I Malformation.Neurosurgery1995;37(2):214-218.
[22]Pietil T, Heimberger K, Palleske H, Brock M. Influence of aneurysmlocation on the development of chronic hydrocephalus following SAH. ActaNeurochirurgica1995;137(1):70-73.
[23]van Gijn J, Rinkel GJE. Subarachnoid haemorrhage: diagnosis, causes andmanagement. Brain2001;124(2):249-278.
[24]McDonald CT， Carter BS， Putman C， et a1． Subarachnoid hemo-rrhage．CurtTreatOptions CardiovascMed，2OO1，3：429-439．
[25]Heinsoo M, Eelm e J, Kuklane M, Tomberg T, Tikk A, Asser T. Thepossible role of CSF hydrodynamic parameters following in management ofSAH patients. Acta Neurochir Suppl1998;71:13-15.
[26]周良辅.现代神经外科学[M]上海：复旦大学出版社；上海医科大学出版社。2001.
[27]Dorai Z, Hynan LS, Kopitnik TA, Samson D. Factors Related toHydrocephalus after Aneurysmal Subarachnoid Hemorrhage. Neurosurgery2003;52(4):763-771.
[28]Kasuya H, Shimizu T, Kagawa M. The effect of continuous drainage ofcerebrospinal fluid in patients with subarachnoid hemorrhage: aretrospective analysis of108patients. Neurosurgery1991;28(1):56-9.
[29]Paré L, Delfino R, Leblanc R. The relationship of ventricular drainage toaneurysmal rebleeding. Journal of Neurosurgery1992;76(3):422-427.
[30]Jartti P, Karttunen A, Jartti A, Ukkola V, Sajanti J, Pyhtinen J. FactorsRelated to Acute Hydrocephalus After Subarachnoid Hemorrhage. ActaRadiologica2004;45(3):333-339.
[31]杭春华,史继新,谭启富,孙克华,邬祖良,王汉东.动脉瘤性蛛网膜下腔出血后脑积水.中华神经外科杂志2001;17(6):3.
[32]魏爱华,刘胜,陈惠芳.脑室引流术后并发脑室感染的原因及防治.中华医院感染学杂志2002;12(9):2.
[33]许刚,张帆,陈谦学.颅脑术后并发颅内感染的高危因素分析.中国临床神经外科杂志2008;13(6):3.
[34]陈风华,刘劲芳,方加胜, et al.脑室-腹腔分流术并发症的防治.中华神经外科疾病研究杂志2006;5(3):2.
[35]成秋生,潘小平.脑室外引流术29例并发症原因分析.广东医学2003;24(6):2.
[36]Passero S, Ulivelli M, Reale F. Primary intraventricular haemorrhage inadults. Acta Neurologica Scandinavica2002;105(2):115-119.
[37]Hellingman CA, van den Bergh WM, Beijer IS, et al. Risk of RebleedingAfter Treatment of Acute Hydrocephalus in Patients With AneurysmalSubarachnoid Hemorrhage. Stroke2007;38(1):96-99.
[38]Liliang P-C, Liang C-L, Lu C-H, et al. Hypertensive Caudate HemorrhagePrognostic Predictor, Outcome, and Role of External Ventricular Drainage.Stroke2001;32(5):1195-1200.
[39]Gjerris F, B rgesen SE, S rensen PS, et al. Resistance to cerebrospinalfluid outflow and intracranial pressure in patients with hydrocephales aftersubarachnoid haemorrhage. Acta Neurochirurgica1987;88(3):79-86.
[40]Pluta RM, Hansen-Schwartz J, Dreier J, et al. Cerebral vasospasmfollowing subarachnoid hemorrhage: time for a new world of thought.Neurol Res2009;31(2):151-158.
[41]宋仁兴,赵奇煌,杨新乾,吴卫.持续腰大池引流在颅内动脉瘤术后的临床应用价值.中国医药导刊2005;7(2):3.
[42]宋奎勤,李新钢.持续腰大池引流在神经外科的临床应用(附220例分析).中国临床神经外科杂志2008;13(1):1.
[43]刘春霖,李卫,曾山.颅内压控制下持续腰大池引流治疗外伤性蛛网膜下腔出血.中华神经医学杂志2004;3(4):3.
[44]Ohwaki K, Yano E, Nakagomi T, Tamura A. Relationship betweenshunt-dependent hydrocephalus after subarachnoid haemorrhage andduration of cerebrospinal fluid drainage. British Journal of Neurosurgery2004;18(2):130-134.
[45]黄如训,施晓耕.蛛网膜下腔出血的重症监护.内科急危重症杂志2003;9(4):4.
[46]Komotar RJ, Olivi A, Rigamonti D, Tamargo RJ. MicrosurgicalFenestration of the Lamina Terminalis Reduces the Incidence of Shunt-dependent Hydrocephalus after Aneurysmal Subarachnoid Hemo-rrhage.Neurosurgery2002;51(6):1403-141310.1227/01. NEU.0000309116.09463.A6.
[47]季楠,赵继宗.动脉瘤性蛛网膜下腔出血后慢性脑积水易患因素分析.北京医学2003;25(3):4.
[48]李金星,朱贤立,赵甲山.动脉瘤性蛛网膜下腔出血后慢性脑积水的研究进展.国外医学(神经病学神经外科学分册)2004;31(2):4.