Aneurysm Surgery in the Acute Stage:Results of Structured Treatment

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概要

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• To evaluate the results of a structured treatment approach to aneurysm surgery in the acute stage, 150 consecutive patients with aneurysmal subarachnoid hemorrhage were studied, including 46 males and 104 females; World Federation of Neurological Surgeons grade I: 21 cases, II: 65, III: 41, IV: 23; day of operation≤day 3:103 cases, ≤day 7:131. Patients underwent angiography on the day of admission or the next followed by surgery. The lamina terminalis and the membrane of Liliequest were routinely opened at surgery. The aneurysm neck was radically clipped after temporary clipping or trapping of the parent arteries. Intraoperative hemodynamic monitoring was used, and the craniotomies were closed without cisternal, epidural, or subgaleal drains. Nimodipine was given perioperatively (48 mg i.v./day for 10 to 14 days). Cases of symptomatic vasospasm were treated with selective intra-arterial adminis-tration of papaverine, sometimes combined with angioplasty. Outcome at discharge and 3 months later is good recovery in 61% and 75%, and death in 6% and 7%. The incidence of symptomatic vasospasm was 17%. Devastating vasospasms were observed in 5%. One-third of patients had mean flow velocities exceeding 120 cm/sec determined by transcranial Doppler sonography between days 4 and 14. Com-municating hydrocephalus necessitating ventriculoperitoneal shunt occurred in 9%. Our results clearly show a favorable outcome compared with previous reports, especially with respect to the reduced occur-rence of fatal vasospasm, hydrocephalus, and technical insufficiency.

• 社団法人 日本脳神経外科学会の論文

著者

• Yonekawa Yasuhiro

  Neurochirurgische Universitatsklinik Zurich Zurich Switzerland

• TAUB Ethan

  Neurosurgical Clinic, University Hospital

• IMHOF Hans

  Neurosurgical Clinic, University Hospital

• OGATA Nobuyoshi

  Department of Neurosurgery, Kyoto City Hospital

• BERNAYS Rene

  Neurosurgical Clinic, University Hospital

• KAKU Yasuhiko

  Neurosurgical Clinic, University Hospital

• FANDINO Javier

  Neurosurgical Clinic, University Hospital

• YONEKAWA Yasuhiro

  Neurosurgical Clinic, University Hospital

関連論文

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• Theodor Kocher, Hayazo Ito, and Harvey Cushing in Berne, Switzerland
• Aneurysm Surgery in the Acute Stage:Results of Structured Treatment

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