持続脳室ドレナージ併用による破裂脳動脈瘤急性期早期手術 : 術後の頭蓋内圧の変動とその対策

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The treatment of subarachnoid hemorrhage following rupture of cerebral aneurysms should be performed from the early period. The authors obtained favorable results by conducting early operation on ruptured cerebral aneurysms using a continuous ventricular drainage during and after the operation. There were 137 cases of ruptured cerebral aneurysms operated between November 1973 and June 1976. The continuous ventricular drainage was indicated on: 1) acute cases (operation was performed within 7 days after the hemorrhage); 2) cases of disturbed consciousness; 3) cases in which vasospasm and dilated ventricles were observed on the preoperative cerebral angiography; 4) cases in which clot, bloody CSF or other troubles were observed during the operation. Thus, the continuous ventricular drainage was performed in 56 cases (40.9%), and in addition, V-P shunt was conducted in 26 of them 11.6 days in average after the operation. Fluctuations of ventricular fluid pressure after the operations of cerebral aneurysms were observed and treated. Because that the cases of the early operation were still under the state of acute hydrocephalus the continuous ventricular drainage was very effective and necessary for monitoring and controlling the postoperative intracranial pressure. As the advantages of continuous ventricular drainage, it prevents the secondary cerebral damage due to increased intracranial pressure, improves cerebral blood flow, decreases the occurrence and progress of vasospasm due to bloody CSF exudation, indicates the precise intracranial pressure, and it helps in making a decision of shunt-operation at the early period. Owing to this last advantage, the occurrence of secondary so-called normal pressure hydrocephalus will be prevented before irreversible changes being induced. In the 10 cases treated by the continuos ventricular drainage along with the continuous chiasmatic cisternal drainage, the chiasmatic cisternal pressure was quite parallel to the ventricular fluid pressure in cases having no block in the basal cistern. The ventricular drainage may be replaced by the continuous chiasmatic cisternal drainage. Thus the authors suggested that the early operation should be positively performed on ruptured cerebral aneurysms using the continuous ventricular drainage.
日本脳神経外科学会の論文

持続脳室ドレナージ併用による破裂脳動脈瘤急性期早期手術 : 術後の頭蓋内圧の変動とその対策

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