前交通動脈瘤破裂急性期手術例の遠隔成績 : 特にmorbidityの推移

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Thirty-one cases of anterior communicating aneurysm operated on under microscope within 2 weeks after subarachnoid hemorrhage (SAH) were analyzed with regards to time courses of their morbidity, especially mental symptoms after surgical treatments. Six out of 15 cases operated on within 7th day after the last SAH (the day of the last SAH was counted as the first day) showed slight disorientation and recovered within 2 weeks (Fig 2, 4) Seven of remaining 9 cases became drowsy due to postoperative vasospasm appearing in the 2nd week after SAH and one case died. In the 3rd week, these 7 cases demonstrated Korsakoff syndrome after recovery of consciousness and 6 became apathetic due to Normal Pressure Hydrocephalus (NPH) and 4 of them recovered by ventriculo-peritoneal shunt(V-P shunt) in the 2nd month after SAH. Sixteen cases underwent direct operation on aneurysm between the 8th and 15th day after SAH and 3 died : one was operate on with Hunt's grade V and 2 showed rebleeding from aneurysm during craniotomy. SIX out of 13 cases demonstrated consciousness disturbance or Korsakoff syndrome due to preoperative vasospasm in their preoperative states and showed more or less deteriorations in their symptoms after operations (Fig. 6). Five cases received V-P shunt and 3 recovered completely in their mental function in the 2nd month after SAH. Follow-up results of cases operated on in the acute stage were not bad comparing with those of cases operated on after the 3rd week after SAH (Table 2). In the surgical treatments of cerebral aneurysm in the acute stage, vasospasm and hydrocephalus are most important factors affecting the prognosis of patients and mental dysfunctions usually recovered by V-P shunt at latest in the 2nd month after SAH. In 5 cases which were operated on in the acute stage and showed residues of mental dysfunctions in their follow-up results, aneurysms were all located in the interhemispheric fissure and such complications as vasospasm and hydrocephalus occurred severely in their courses.
日本脳神経外科学会の論文

前交通動脈瘤破裂急性期手術例の遠隔成績 : 特にmorbidityの推移

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