21. 急性期破裂脳動脈瘤の手術のポイント

概要

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Prevention of rebleeding is thought to be the main purpose of surgery in intracranial aneu ysms. But in acute stage, the management of the subarachonoid hemorrhage is more important since it is the cause for the neurological deterioration of the patient in acute stage. Hence the method of SAH is very important in acute stage.<BR>351 cases of direct aneurysm operation have been done. This includes 130 cases of early operations is within 24 hours of onset.<BR>CT is essential to select the mode of management. Along with the management of the SAH, decompose of the swollen brain should also be considered. When the SAH is minimal and is conbined to the basal cisterns, direct aneurysm operation could be taken up on the usual way. When this is accompanied by hydrocephalus, ventricular tap just before craniotomy is necessary. When there is hematoma, this should be evacuated partially or completely before approaching the aneurysms. The evacuation should be done by the pterional approach. Cisternal drainage should be established for more than 2 weeks of post operative period.<BR>When the hematoma is found in the ventricle, in the interhemispheric fissure or frontal lobe, interhemispheric approach is better.<BR>When the patient in neurological Gr IV external decompression should be given.