MRimaging findings after ventricular puncture in patients with SAH.
OBJECTIVE
Using magnetic resonance (MR) imaging, we studied brain injury from ventricular puncture performed during craniotomy in the acute stage of subarachnoid hemorrhage (SAH).


METHODS
80 patients underwent craniotomy for aneurysm obliteration within 48 hr after SAH, ventricular puncture for drainage of cerebrospinal fluid (CSF) was performed to reduce intracranial pressure. MR imaging was performed within 3 days following surgery to measure the size of the lesion, and was repeated on postoperative days 14 and 30.


CONCLUSIONS
Of the 80 patients with ventricular puncture preceding craniotomy, 65 (81%) showed MR evidence of brain injury from the puncture. Overall, 149 lesions were detected. According to coronal images, cortical injuries (54 cases), penetrating injury to tracts along the ventricular tube (55 cases), caudate injury (25 cases), and corpus callosum injury (15 cases). Brain injuries from ventricular puncture did not correlate significantly to patient outcome. While ventricular puncture and drainage of CSF can readily be performed to decrease brain volume at the time of craniotomy in acute-stage SAH, neurosurgeons should be aware of a surprisingly high incidence of brain injury complicating puncture.
Tominaga
J
J
Department of Neurosurgery, Tokai University School of Medicine, Kanagawa, Japan.
Shimoda
M
M
Oda
S
S
Kumasaka
A
A
Yamazaki
K
K
Tsugane
R
R
D000208:Acute Disease; D000368:Aged; D001930:Brain Injuries / Q000134:cerebrospinal fluid / Q000473:pathology*; D002552:Cerebral Ventricles / Q000601:surgery; D003399:Craniotomy / Q000379:methods*; D004322:Drainage; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery*; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011677:Punctures / Q000009:adverse effects*; D013345:Subarachnoid Hemorrhage / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome