To evaluate the role of intraoperative ventricular drainage in Ⅳ~Ⅴ grade ruptured intracranial aneurysm.

The clinical data of 63 cases with Hunt-Hess grade Ⅳ~Ⅴ ruptured intracranial aneurysms were collected retrospectively in the department of Neurosurgery in Yantai Affiliated Hospital of Binzhou Medical University between June 2010 and February 2019. All 63 cases underwent craniotomy aneurysm surgery, preoperative surgical clipping of the aneurysm, and the Paine-point line with the lateral ventricle puncture. Postoperative prognosis of all patients was evaluated according to Glasgow Outcome Rating Scale (GOS).

Among all patients, 62 underwent routine aneurysm surgery, and the other one who was with severe atherosclerosis underwent the outer wall of the aneurysm strengthen surgery. Intracranial pressure dropped by an average of 177.15 mmH₂O during the operation and an average of 27.85 ml of cerebrospinal fluid was released after the operation. After 6 months of follow-up, the incidence of hydrocephalus was 9.52% (6/63) and the incidence of cerebral infarction was 30.2% (19/63). According to GOS and after a followed up of 6 months, 30 cases presented with good recovery, 8 with moderate disability, 13 with severe disability, and 12 ended with deaths.

In Hunt-Hess grade Ⅳ~Ⅴ ruptured intracranial aneurysm surgery, ventricular drainage can effectively reduce intracranial pressure in favor of dissecting sylvian to reveal aneurysm and conducive aneurysm, and mitigate brain damage, cerebral vasospasm and hydrocephalus.