Neurochirurgie
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After subarachnoid hemorrhage (SAH), cerebral vasospasm (VS) may be revealed by cerebral angiography, during follow-up clinical examination with the occurrence of delayed ischemic deficit (DID). Moreover, transcranial Doppler (TCD) could be useful in determining the level of the velocimetric threshold. The aims of the study were, on a prospectively collected series of 460 patients, to assess angiographic VS incidence, to determine possible risk factors, and to evaluate diagnostic sensitivity and specificity of TCD. ⋯ The unique risk factor for angiographic VS and DID was the admission date. TCD demonstrated high specificity but its sensitivity was too low for the aneurysms located far from the middle cerebral artery bifurcation.
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We report two cases of intraventricular hematoma with obstructive hydrocephalus. We perform endoscopic treatment of the hydrocephalus: aspiration of the hematoma associated with a third ventriculostomy. Both patients respectively aged 59 and 74 years had an obstructive hydrocephalus due to intraventricular hemorrage. ⋯ If possible, waiting for 6 or 5 days to allow the structuring of the blood clot and using large irrigation RL may facilitate the endoscopic procedure. This indication for endoscopic third ventriculostomy constitutes an alternative to external ventricular drainage which is significatively associated with complication (infection and obstruction). We cannot affirm that the removal of the clots and ventriculocisternostomy versus temporary external drainage avoids secondary hydrocephalus.