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題名 | Treatment of Intraventricular Hemorrhages Using Percutaneous Long Tunnel Ventriculostomy Combined with Urokinase= |
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作者 | Pan,Hung-chuan; Wang,Yeou-chih; Wei,Shan-hua; Shen,Chiung-chyi; Sun,Ming-his; |
期刊 | Acta Neurologica Taiwanica |
出版日期 | 20010900 |
卷期 | 10:3 2001.09[民90.09] |
頁次 | 頁181-185 |
分類號 | 416.291 |
語文 | eng |
關鍵詞 | 腦室出血; 尿激素; Intraventricular hemorrhage; Percutaneous long tunnel ventriculostomy; Urokinase; Ventricular reservoir; |
英文摘要 | The treatment of intraventricular hemorrhages (IVH) using external entricular drainage and an intrathecal urokinase injection has been known to produce a favorable outcome. However, the incidence of delayed hydrocephalus is about 30%. In this study, we combined a long tunnel ventriculostomy with a ventricular reservoir and urokinase injection to treat IVH and evaluated the potential of this combination in reducing the incidence of delayed hydrocephalus. Ten patients who underwent a percuatneous long tunnel ventriculostomy with a ventricular reservoir were included in this study. All patients had intracerebral hemorrhages (8 in the thalamus and 2 in the putamen) with ruptures into the ventricles. Eight cases had acute hydrocephalus and three cases had hemorrhages which extended to the midbrain. After percutaneous long tunnel vernventriculostomy with ventricular reservoir, all patients received urokinase through the reservoir at a does of 20000 IU/day for 7 days. Computed tomography (CT) scans were performed immediately and at 7 days and 21 days after ventriculostomy. Cell counts and bacterial culture of the cerebrospinal fluid (CSF) were done on the 7th and 21st days. The ventricular tip was also sent for bacterial culture after removal. The follow-up period ranged from 8 to 15 months (12.4±2.5 months). Seven patients gained neurological improvement, four returned to clear consciousness. Five patients developed delayed hydrocephalus except for one who received a permanent ventriculo-perioneal shunt after 3 weeks of follow-up. The red blood cell counts of CSF were 5200±1540/mm3 and 56±24/mm3 on the 7th and 21st days, respectively. There was no shuntassociated infection. The CT scans of the brain on the 7th day showed complete clearing of IVH at all patients. One patients had shunt obstruction on the 15th day but regained patency after intrathecal urokinase injection. A percutaneous long tunnel ventriculostomy combined with a reservoir and intrathecal urokinase injection is a simple and effective technique for the treatment of IVH. The benefits included low infection rate, easy administration of urokinase and prolonged CSF drainage. Whether or not a lower incidence of delayed hydrocephalus, mortality rate and improvement of neurological function after using this combined treatment method needs further investigation. |
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