破裂脳動脈瘤の緊急手術 : クモ膜下出血後5日以内の症例について

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1. Emergency operations were performed on 27 consecutive cases admitted to Shizuoka Rosai Hospital within 5 days after the last episode of subarachnoid hemorrhage from January 1974 through the end of June 1976. The results included 22 cases (81.5%) who could return to social life and 2 fatal cases (7.4%). 2. Among these the surgical results were not varied by the time elapsed after the last episode of subarachnoid hemorrhage, if it was within the period of 5 days. One case showed vasospasm before surgery, which did not affect the postoperative course. A symptomatic vasospasm was observed only in one other case postoperatively. 3. The site of aneurysm did not influence the surgical results. Hence a vertebrobasilar aneurysm could be operated upon on an emergency basis. 4. There were no differences in the surgical results according to the grades I to IV (cooperative study, Nishioka) except for elderly patients of grade IV. 5. As for the age, the patients with grade IV over the age of 65 years sustained a poor postoperative prognosis. 6. Since a high blood pressure is one of the risk factors for rerupturing, a hypertensive patient is a good candidate for the emergency operation. 7. In order to perform the surgery on an emergency basis successfully it was essential to eliminate any complicated procedures before and during the surgery to save time. For this purpose with the use of neuroleptanalgesia the operations were performed under normothermia with temporarily induced hypotension. Skin shaving of the operating field, blood transfusion and administration of antibiotics were unnecessary. Operating time ranged from an hour and a half to 4 hours, mostly within 3 hours. Neither ventricular nor cisternal drainage were usuallyindicated. 8. Routine procedures included adequate irrigation of the blood in both subarachnoid space and basal cistern and opening of the Liliequist's membrane to facilitate enough communication between supra- and infratentorial CSF pathways. With early postoperative RI-cisternographies no blockage in the basal cistern was observed. 9. Ruptured aneurysms should be and could be operated upon as quickly and safely as possible only with a well-arranged emergency surgery unit and squad in the hospital and with the skilled hands of neurosurgeons.
日本脳神経外科学会の論文

破裂脳動脈瘤の緊急手術 : クモ膜下出血後5日以内の症例について

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