23. 広範囲クモ膜下凝血除去術

概要

論文の詳細を見る
To evaluate the effect of removal of subarachnoid blood clots on the prevention of delayed ischemic deficit, 239 consecutive cases hospitalized within 24 hours after rupture of cerebral aneurysms were analyzed. They were classified in Grades 1 to 4 according to the system of Hunt and Hess.<BR>Delayed ischemic deficit causing permanent disability and death occurred significantly less frequently in the patients who underwent radical operation in which subarachnoid blood clots were removed extensively and aggressively along the arteries in addition to clipping the aneurysms within 48 hours after the onset, than in the patients whose operations were planned to be delayed or the patients in whom aneurysms were clipped within 48 hours after the onset but subarachnoid clots were not removed radically.<BR>In the group of radical operation, the outcome was more favorable than in the other treatment groups. If the patients 70 years old or more who consisted more than half of the patients with unfavorable outcomes had been excluded, the outcome might be much better.<BR>Recently, the subarachnoid clots are removed by sharp flow of saline ejected through a small and fine needle during the radical operation. This technique avoids the mechanical stimuli to the vessels by a suction tube and minimizes the injury to the brain.