破裂脳動脈瘤をいつ手術するか

概要

論文の詳細を見る
The authors surveyed the follow-up results of 5l2 microsurgically-treated cases with ruptured cerebral aneurysms during the last 10 years and discussed the timing and indications of surgery for ruptured cerebral aneurysms. Among these cases, 54 underwent surgery of the aneurysm within 3 days after subarachnoid hemorrhage (SAH), 57 between day 4 ( the SAH day was counted as day I ) and 8, and 72 cases in the second week. Operative mortality was 5.5%, and 82.2% of the total cases returned to their previous work. The authors' principles of surgical treatment of ruptured cerebral aneurysms were as follows: 1) Patients in Grade 1 or 2 (Hunt's grading) can safely undergo operations on aneurysms on any day after SAH. 2) During the first 3 days after SAH, cases in Grade 3 can also be operated on. Nine out of 11 cases could lead useful social lives. However, in cases of Grade 4, microsurgery of aneurysms should be postponed during this period except cases with intracerebral hematoma. Washout of cisternal blood clots was not always easy and postoperative vasospasms which exert a crucial influence on the prognosis of patients could not be prevented. Only three out of nine cases returned to their previous work. 3) Between day 4 and day 8, surgery of aneurysms in cases of Grades 3 and 4 should be postponed. Our data showed that the operative mortality of these cases was highest (33.3%) due to development of postoperativevasospasms. 4) After day 8, any cases which exhibit neurological deterioration should be subjected to repeated angiographic examinations to detect vasospasms and to follow their course. If vasospasms are present, surgery should be postponed until the vasospasms begin to subside and disturbance of the consciousness begins to improve. Early operations (during the first 3 days after SAH) did not always prevent development of postoperative vasospasms according to our data for the last 10 years. However, recent CT scans revealed that vasospasms did not develop when no cisternal blood clots were present and complete washout of these clots by early operations can be expected to prevent postoperative vasospasms.
日本脳神経外科学会の論文
1981-03-15

破裂脳動脈瘤をいつ手術するか

スポンサーリンク

概要

著者

関連論文

スポンサーリンク