Ommaya囊结合侧脑室外引流治疗重度脑室出血的临床研究

目的探讨Ommaya囊穿刺引流结合侧脑室外引流在重度脑室出血中的应用及意义。方法将我科2007年2月至2012年2月收治的46例重度脑室出血患者随机分为:Ommaya囊结合侧脑室外引流治疗组和单纯侧脑室外引流组,将两组患者疗效进行对比分析。结果 Ommaya囊治疗组的交通性脑积水及颅内感染发生率明显低于单纯脑室外引流组(P0.05),术后3个月GOS评分:Ommaya囊治疗组良好8例,中残10例,重残3例,死亡3例;单纯外引流组良好5例,中残4例,重残8例,死亡5例。Ommaya囊治疗组治疗有效率高于单纯外引流组(P0.05)。结论 Ommaya囊穿刺引流结合侧脑室外引流治疗重度脑室出血,可以降低颅内感染及脑积水发生率,改善患者预后,提高生存质量,是脑室出血安全、有效的治疗方法。     

Ommaya囊联合侧脑室外引流治疗高血压脑室出血

目的探讨高血压脑室出血的治疗方法并评价其临床疗效。方法对17例高血压脑室出血患者采用Ommaya囊联合侧脑室外引流并早期注入尿激酶治疗。结果存活14例，死亡3例。有效随访14例，随访时间3-6月，其中恢复良好4例，中残6例，重残3例，植物生存1例。结论Ommaya囊联合侧脑室外引流并早期注入尿激酶治疗高血压脑室出血具有操作简单、并发症相对较少的优点．是治疗高血压脑室出血的一种新的有效方法。     

Ommaya囊联合侧脑室外引流治疗脑室出血疗效观察

我科自2007-03~2009-12采用Ommaya囊联合侧脑室外引流加尿激酶灌注治疗脑室出血43例,取得较为满意的疗效,报告如下。1资料与方法1.1一般资料男26例,女17例;年龄15~82岁,平均54.6岁。高血压性32例,血管畸形性3例,不明原因8例;入院时GCS评分3~5分5例,6~8分27例,9~12分11     

Ommaya囊并脑室外引流在丘脑出血破入脑室中的应用研究

目的探讨Ommaya囊并脑室外引流在丘脑出血破入脑室中的应用效果。方法纳入我院2013-01—2014-11确诊为高血压脑出血破入脑室患者100例,随机均分为2组,观察组50例采用Ommaya囊联合脑室外引流治疗,对照组50例只采用脑室外引流治疗。比较2组再出血率、并发症发生率和总体预后情况。结果与对照组比较,观察组再出血率、并发症发生率均低于对照组,差异有统计学意义(P0.05);观察组总体预后优于对照组,差异有统计学意义(P0.05)。结论Ommaya囊联合脑室外引流能够合理控制颅内压,降低了再出血率,改善了患者的预后,减少了并发症,安全性高,疗效更好。     

Ommaya囊联合侧脑室外引流治疗脑室内出血

目的探讨脑室内出血(IVH)的治疗方法并评价其临床疗效。方法 40例IVH病例随机分为改良组及传统组。改良组选择在出血相对较多的一侧常规行侧脑室额角穿刺外引流;而在出血相对较少的一侧额角置入Ommaya囊后行囊腔穿刺外引流。脑室外引流5~7 d后,改为仅Ommaya囊穿刺外引流。传统组则行双侧侧脑室普通外引流,5~7 d后结合腰大池置管持续引流血性脑脊液治疗。比较两组患者迟发性脑积水、颅内感染发生率及预后情况等。结果两组迟发性脑积水、颅内感染发生率及预后(ADL分级)比较差异有统计学意义(P0.05),表明改良组疗效明显优于传统组。结论该项改良技术安全可靠、损伤小、恢复快,能大大降低病死率和伤残率,减少并发症和后遗症,改善预后,优于传统方法。     

脑室穿刺引流治疗原发性脑室出血

脑室穿刺引流治疗原发性脑室出血杨建芳原发性脑室出血（ＰｒｉｍａｒｙＩｎｔｒａｖｅｎｔｒｉｃｕａｒＨｅｍｏｒｒｈａｇｅ简称ＰＩＶＨ），一直被认为是病情严重、预后不良的疾病［１］，但近年来由于ＣＴ问世及治疗水平的提高，特别是脑室穿刺术技术的开展，已明显降...     

颅内压监测指导下穿刺引流+Ommaya囊置入术治疗基底节区出血破入脑室

目的 探讨颅内压监测指导下穿刺引流+Ommaya囊置入术高血压性基底节区出血破入脑室的疗效。方法 回顾性分析2016年1月至2019年1月在颅内压监测指导下穿刺引流+Ommaya囊置入术治疗的40例高血压性基底节区出血破入脑室的临床资料。结果 术后1周内均顺利拔除血肿腔引流管。术后无颅内感染及脑积水。术后3 d颅内压平均（25.6±4.3）mmHg,GCS评分平均（9.4±3.6）;术后1周,颅内压平均（18.7±3.8）mmHg,GCS评分平均（10.3±2.2）。术后1周颅内压明显下降（P<0.05）,术后1周GCS评分无明显变化（P>0.05）。术后6个月,预后良好率为70%(28/40)。结论 颅内压监测指导下穿刺引流+Ommaya囊置入术治疗基底节区出血破入脑室,手术创伤小,并发症少,可以有效提高疗效。     

Ommaya管植入并持续腰大池引流治疗重症脑室出血

脑室出血临床较为常见.出血后脑脊液循环通路被堵塞,导致出血后急性脑积水发生,此为脑室出血最常见的并发症,并认为是导致脑室出血预后不良的主要原因Ⅲ.脑室外引流、反复腰大池穿刺或持续腰大池引流行脑脊液置换是治疗脑室出血的有效措施,目前在临床已得到普遍应用,但却有引流时间短、易感染、患者痛苦、引流管易堵塞等缺点.常熟市第二人民医院神经外科自2007年1月至2010年3月共收治27例重症脑室出血患者,对其应用Ommaya管进行侧脑室前角穿刺外引流加尿激酶冲洗,必要时清除脑室外血肿,同时采用美敦力体外引流及监测系统进行持续腰大池引流,取得了较为满意的疗效,现报道如下.     

微创颅内血肿穿刺加脑室引流治疗高血压性脑室出血的临床观察

目的研究微创颅内血肿穿刺加脑室引流治疗高血压脑室出血的疗效。方法保守组单纯保守治疗，予控制血压、降颅压、抗脑水肿等。微创组在以上治疗基础上行颅内血肿穿刺加侧脑室前角穿刺引流术。比较两组病死率及术后临床疗效。结果微创组病死率低于保守组（P〈0．05）；术后临床疗效评价微创组有效率高于保守组（P〈0．05）。结论微创颅内血肿穿刺加脑室引流走是治疗高血压脑室出血一种快捷有效的途径。     

Ommaya囊辅助侧脑室穿刺引流术在高血压小脑出血治疗中的应用

目的：探讨Ommaya囊辅助侧脑室穿刺引流术治疗高血压小脑出血的临床疗效。方法对28例小脑出血患者行Ommaya囊埋置侧脑室引流术, Ommaya囊穿刺外引流脑脊液。结果28例患者中无1例发生颅内感染。根据患者出院时的GOS评级：预后良好l7例,中残8例,重残1例,死亡2例。结论 Ommaya囊辅助侧脑室穿刺引流术是对常规脑室外引流治疗小脑出血安全、有效的改进方法,能有效减少并发症。     

立体定向Ommaya囊置入治疗脑脓肿45例

我院自1998年9月至2006年2月，通过CT精确定位，应用立体定向技术向脓肿腔内置入Ommaya囊治疗脑脓肿45例，现报告如下。[第一段]     

Spontaneous Cerebellar Hemorrhage with the Fourth Ventricular Hemorrhage : Risk Factors Associated with Ventriculoperitoneal Shunt

Objective

The purposes of this study are to investigate the factors that may be related to ventriculoperitoneal (VP) shunt in patients with cerebellar hematoma and the effect of severe fourth ventricular hemorrhage, causing obstructive hydrocephalus on subsequent VP shunt performance.

Methods

This study included 31 patients with spontaneous cerebellar hematoma and concomitant fourth ventricular hemorrhage, who did not undergo a surgical evacuation of hematoma. We divided this population into two groups; the VP shunt group, and the non-VP shunt group. The demographic data, radiologic findings, and clinical factors were compared in each group. The location of the hematoma (whether occupying the cerebellar hemisphere or the vermis) and the degree of the fourth ventricular obstruction were graded respectively. The intraventricular hemorrhage (IVH) score was used to assess the IVH severity.

Results

Ten out of 31 patients underwent VP shunt operations. The midline location of cerebellar hematoma, the grade of fourth ventricle obstruction, and IVH severity were significantly correlated with that of VP shunt operation (p=0.015, p=0.013, p=0.028). The significant variables into a logistic regression multivariate model resulted in statistical significance for the location of cerebellar hemorrhage [p=0.05; odds ratio (OR), 8.18; 95% confidence interval (CI), 1.00 to 67.0], the grade of fourth ventricle obstruction (p=0.044; OR, 19.26; 95% CI, 1.07 to 346.6).

Conclusion

The location of the cerebellar hematoma on CT scans and the degree of fourth ventricle obstruction by IVH were useful signs for the selection of VP shunt operation in patients with spontaneous cerebellar hematoma and concomitant acute hydrocephalus.     

Physiological Effects of Early Incremental Mobilization of a Patient with Acute Intracerebral and Intraventricular Hemorrhage Requiring Dual External Ventricular Drainage

Background

The American Academy of Neurology (AAN) has established a core curriculum of topics for residency training in neurocritical care. At present there is limited data evaluating neurology residency education within the neurological intensive care unit. This study evaluates learner concerns with the neurological intensive care unit.

Methods

The Communication Committee and Resident & Fellow Taskforce within the Neurocritical Care Society (NCS) developed an online survey that consisted of 20 selection and free-text based questions. The survey was distributed to NCS members and then to neurology residency program directors. Statistical analysis of neurocritical care exposure were completed with t or Fisher exact test with p-value <0.05 considered significant.

Results

A total of 95 individuals from 32 different residency programs (36.5 % response rate) responded to the questionnaire. Most individuals train with neurocritical care attendings, fellows and advanced practitioners and have neurocritical care exposure during multiple years of residency training. 54 % of responders cite improvement in education as a means to improve neurocritical care training. Those that raised concern had no difference in time in the neurocritical care unit (9.4 weeks vs 8.8 weeks), exposure to trained neurointensivists, neurocritical care fellows or advanced providers (p value 0.53, 0.19, 0.83, respectively).

Conclusions

There is significant learner concern regarding education within the neurointensive care unit. Although there are educational guidelines and focused neurocritical care educational materials, these alone do not satisfy residents’ educational needs. This study demonstrates the need for educational changes, but it does not assess best strategies nor curricular content.

     

Implantation of Ommaya reservoir in extremely low weight premature infants with posthemorrhagic hydrocephalus: a cautious option

Objective

This study aims to evaluate effects and complications of the implantation of Ommaya reservoir in premature infants with posthemorrhagic hydrocephalus (PHH).

Methods

The effects and complications of the implantation of Ommaya reservoir in seven premature infants with PHH were retrospectively analyzed. Intracapsular puncture of the reservoir was performed for draining cerebrospinal fluid.

Results

Seven extremely low-weight premature infants with PHH (birthweight less than 1,000?g) were treated with the placement of an Ommaya reservoir. Ommaya reservoirs in five infants were removed, but were retained in two infants. Two premature infants had to undergo ventriculoperitoneal (VP) shunt. Postsurgical major complications (including skin dehiscence, cerebrospinal fluid (CSF) infection, ventricular hemorrhage, and CSF leak) occurred in 57?% of all patients. Three infants of skin dehiscence and CSF leak occurred. Two infants of CSF infection occurred, as well as one clinically significant secondary hemorrhage. Six infants survived, and one died.

Conclusion

The implantation of Ommaya reservoir is a cautious option of treating low-weight premature infants with PHH because of a relatively high complication rate. However, VP shunt surgery may be avoided in some infants.     

立体定向穿刺加Ommaya囊置入术在颅内囊性病变中的临床应用

目的探讨立体定向穿刺术和Ommaya囊置入术在治疗颅内囊性病变中的应用技巧及疗效。 方法回顾性分析上海华山医院伽马分院2012年11月至2013年4月收治的3例不同颅内囊性病变患者,对该3例诊断明确的颅内囊性患者(分别为右颞转移瘤、左侧CPA神经鞘瘤、颅内多发病变)在立体定向穿刺后置入Ommaya囊,再根据具体病情给予囊腔逐渐抽吸,使囊液逐渐减少至最少,给予伽玛刀的治疗方法。 结果3例病例均在多次抽取囊液后行伽玛刀治疗,无不适反应,均未出现皮肤感染、颅内感染、硬膜外血肿等因手术操作导致的并发症。 结论治疗颅内囊性病变,尤其是高龄病人或由于其他原因不能耐受全麻手术的患者时,立体定向加Ommaya囊置入术不失为一种简便、经济、有效、微创的好方法。