塞栓術を行った破裂脳動脈瘤例における脳血管攣縮の検討

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We analyzed the incidence of vasospasm (VS) of the cerebral arteries in the patients treated with coil embolization using Guglielmi detachable coils (GDCs) for ruptured cerebral aneurysms, and herein we report the details. Between March 1997 and March 2005, 52 patients underwent coil embolization within 7 days following rupture of cerebral aneurysms. We excluded 8 patients in whom VS could not be judged due to prolonged disturbance of consciousness resulting from early brain damage consequent to subarachnoid hemorrhage (SAH); early mortality; or other causes, as well as 2 patients in whom VS was already detected at the time of coil embolization. The remaining 42 patients (mean age: 64.4 years) were the subjects of our study. When thick hematomas were revealed on CT scans, spinal drainage was placed until SAH disappeared, while 3H therapy was actively conducted if the patients showed any manifestations of VS. In addition, when no improvement could be achieved, intra-arterial injection of papaverine hydrochloride was administered or (simultaneous) vascular reconstruction was performed. Preoperatively, H & H grade was I in 1 case, II in 16 cases, III in 6 cases, IV in 17 cases, and V in 2 cases. In the Fisher CT group, the grade was 1 in 1 case, 2 in 13 cases, 3 in 25 cases, and 4 in 3 cases. In 11 of the 42 patients (26.2%), cerebral VS was noticed, and the manifestations such as hemiplegia persisted in 3 (7.1%). The incidence of symptomatic cerebral VS following craniotomy is reportedly about 15% to 30%, but in our present study we found that the incidence was relatively slightly lower following coil embolization. Our results suggest that comparative studies on post-craniotomy cerebral VS should be conducted.
日本脳卒中の外科学会の論文
2006-07-31

塞栓術を行った破裂脳動脈瘤例における脳血管攣縮の検討

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