Treatment Policy for Grade IV and V Patients

概要

論文の詳細を見る
To settle the controversy over optimum management strategy for patients with poor-grade (Hunt and Hess grade IV and V) aneurysmal subarachnoid hemorrhage (SAH), the medical records of 50 patients admitted with poor Hunt and Hess grade have been examined retrospectively with literature review. Initial findings such as better neurological condition (Hunt and Hess grade IV) and presence of intracerebral hemorrhage were indicators of good prognosis. Patients with intraventricular hemorrhage and uncontrollably increased intracranial pressure (>40 cm H_20 after extraventricular drainage) resulted in severe morbidity or mortality. Regarding the timing of surgery, early intervention led to a better outcome with less morbidity because of the marked decrease of the severity of vasospasm and the incidence of rebleeding. The frequency of intraoperative premature rupture and the overall mortality were not significantly influenced by the timing of surgery. It is concluded that, for patients in poor Hunt and Hess grade without a definite evidence of irreversibility such as brainstem failure signs or uncontrollably increased intracranial pressure, early surgery followed by aggressive treatment to prevent cerebral vasospasm is the treatment of choice.
日本脳神経外科コングレスの論文
1995-05-20