高齢者くも膜下出血に対する治療戦略 : 特に重症例に対して

概要

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In a series of 91 patients over 75 years of age with ruptured cerebral aneurysm, 59 patients were operated with clipping. Twenty-seven patients were not operated on because of re-rupture or deterioration of their general condition or refusal, among other reasons. We classified their neurological grade according to World Federation of Neurosurgical Societies and evaluated their outcome at discharge with Glasgow Outcome Scale. Thirty-one were operated on in the acute stage (within 3 days after onset), and 27 were operated on in the delayed stage (at least 10 days after onset). Our conclusions are: 1. Ruptured aneurysms in patients over 75 years old occur about 3 times more often in females than inmales. 2. Clipping should be performed in the acute stage for the treatment of ruptured aneurysms and will result in better operative results even among patients over 75 years of Gr IV, V. 3. We treat patients with a more careful operative technique especially, for ruptured aneurysms located in the anterior communicating artery. 4. Symptomatic vasospasm occurred more frequently in elderly patients (20%) than in younger patients (10%), but timing of surgery did not influence the occurrence of symptomatic vasospasm. 5. Aged patients with subarachnoid hemorrhage have various pulmonary and/or cardiovascular complications, so careful postoperative management is essential.
日本脳卒中の外科学会の論文
2003-07-31