脳血管攣縮期における破裂動脈瘤の手術成績

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The timing of aneurysmal surgery in patients within the period of vasospasm is controversial. In this study we review our experience of surgically treated patients. From April 1996 to March 2006, 529 patients presented with an aneurysmal subarachnoid hemorrhage (SAH) and were treated with early surgery. We retrospectively analyzed the patients that had been admitted to our hospital during day 5 to 13 after first the attack of SAH called the subacute operation group. In this study, angiographic vasospasm was characterized in terms of vessel narrowing of less than 50%, and symptomatic vasospasm was diagnosed when a decreased level of consciousness and/or focal deficit occurred after SAH in the presence of angiographic vasospasm without confounding factors. Functional outcomes were assessed on discharge using the Glasgow Outcome Scale (GOS). We also statistically compared the subacute operation group and the overall group in which an aneurysmal surgery was performed within 3 days after onset in the same period. Of 13 patients studied, 84.6% were in good clinical grade Hunt & Hess (H&H 1-2) on admission. Intermediate grade: 7.7% (H&H 3); poor grade: 7.7% (H&H 4-5). The good grade in the subacute operation group was significantly more frequent than that in the overall group (p<0.05). Surgery was performed within 24 hours after admission in 92.3% of patients and less than 48 hours in 100%. Preoperative angiographic vasospasm was diagnosed in 15.4%, and no symptomatic vasospasm was observed. Postoperatively, angiographic vasospasm was documented in 23.1% and symptomatic vasospasm in 7.7%. The presence of postoperative angiographic and symptomatic vasospasm in the subacute operation group was similar to that in the overall group. The functional outcome was 84.6% in good recovery, 7.7% in severely disabled and 7.7% in vegetative survival. GOS in the subacute operation group was more favorable than that in the overall group (p G 0.05). Aneurysmal surgery between day 5 and 13 after SAH is not necessarily contraindicated and might enable optimal treatment of vasospasm in patients in good clinical grade.
日本脳卒中の外科学会の論文
2008-07-31

脳血管攣縮期における破裂動脈瘤の手術成績

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