本邦における重症くも膜下出血に対する治療の現況 : 全国アンケート調査より(重症くも膜下出血治療の新しい試み)

元データ 2001-07-31 日本脳卒中の外科学会

概要

Improvement in the outcome of good grade subarachnoid hemorrhage (SAH) patients has recently been reported. However, the management and therapeutic indication for poor grade SAH patients is still controversial. To elucidate the current therapeutic strategy and the trends toward endovascular or hypothermic treatment for poor grade SAH patients in Japan, we sent a nationwide questionnaire to 1,228 neurosurgical institutes and analyzed 661 (51.3%) replies. In World Federation of Neurological Surgery (WFNS) Gr IV patients, aggressive radical treatment in the acute stage was performed in patients of from 70 to 80 years of age in 80% of institutes. In WFNS Gr V patients presenting with brain stem reflex, the therapeutic strategy in the responding institutes was as follows. A radical operation for the obliteration of the aneurysm was performed when the patients showed neurological improvement by course observation, dehydration therapy, or external cerebrospinal fluid (CSF) drainage in 20%, 80% and 65% of the responding institutes, respectively. On the contrary, emergency radical operations were always attempted in all cases in 20% of the responding institutes. In the case of intracerebral hemorrhage (ICH), emergency operations were performed even in comatose patients in 70% of the institutes. Endovascular obliteration of cerebral aneurysms was attempted in 30% of the institutes. The reasons for the endovascular treatment included the patient's poor physical condition, the advanced age of the patient, or the presence of an aneurysm of the posterior circulation. Hypothermic therapy for poor grade SAH patients was performed in 20% of the institutes. Although the aim of this latter therapeutic method was mainly to limit the primary brain damage or to control intracranial pressure (ICP), prophylaxis against vasospasm was unlikely. In conclusion, aggressive treatment for poor grade SAH patients is performed in most institutes in Japan. We need more evidence to prove the efficacy of aggressive treatment for poor grade SAH patients, particularly in the case of endovascular or hypothermic treatment.

著者

河瀬 斌 慶應義塾大学脳神経外科
河瀬 斌 慶應義塾大学医学部外科学教室脳神経外科
河瀬 斌 慶應義塾大学医学部脳神経外科
稲桝 丈司 慶應義塾大学医学部救急部
河瀬 斌 慶応義塾大学 医学部脳神経外科
赤路 和則 美原記念病院 脳神経外科
菅 貞郎 慶應義塾大学脳神経外科
河瀬 斌 さいたま市立病院 脳神経外科
真柳 圭太 慶應義塾大学脳神経外科
菅 貞郎 慶應義塾大学医学部脳神経外科
菅 貞郎 美原記念病院
菅 貞郎 慶應義塾大学
赤路 和則 慶應義塾大学医学部脳神経外科
稲桝 丈司 慶應義塾大学医学部脳神経外科
稲桝 丈司 慶應義塾大学医学部外科学教室
真柳 圭太 慶應義塾大学医学部脳神経外科
河瀬 斌 Department Of Neurosurgery School Of Medicine Keio University
河瀬 斌 慶應義塾大学

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