<Originals>Computerized tomographic study of vasospasm prediction after acute aneurysm surgery
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概要
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Persistence of blood in large subarachnoid spaces after acute aneurysm surgery may play a major role in the later development of vasospasm, because blood in these spaces is probably the dominant source of spasmogenic substances. There are three subarachnoid spaces on horizontal computerized tomography (CT) slices where a large amount of blood may accumulate. One is the suprasellar cistern at the midline. The other two are a pair of trigonal spaces representing the largest portions of the Sylvian fissures. A study of 169 patients with supratentorial cerebral aneurysms operated on via a pterional approach within 48 hours of aneurysm rupture was undertaken to investigate the relationship of postoperative persistence of blood in the Sylvian trigonal space and suprasellar cistern to the later development of vasospasm in the middle and anterior cerebral arteries on follow-up angiograms, respectively. Persistence of blood totally filling one of those large subarachnoid spaces was related to a high incidence of symptomatic and/or severe vasospasm of the artery passing through it ; failure in blood removal was exclusively observed in the Sylvian trigonal spaces, especially on the side contralateral to the surgical approach. However, when blood only partially filled one of those spaces, symptomatic vasospasm did not develop in the corresponding artery regardless of clot removal. In conclusion, regional vasospasm prediction is possible on postoperative CT by evaluating the persistence of blood clots in the Sylvian trigonal space and in the suprasellar cistern, and preoperative degree of blood filling in those large subarachnoid spaces may be a practical and reliable indicator of the need for clot removal.
- 近畿大学の論文
著者
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TANEDA Mamoru
Department of Neurosurgery, Kinki University School of Medicine
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Taneda Mamoru
Department Of Neurosurgery Kinki University School Of Medicine
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Taneda Mamoru
Department Of Neurological Surgery Osaka National Hospital
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