25. 破裂脳動脈瘤急性期手術における脳槽ドレナージュに関する一考察

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In order to prevent post-operative vasospasm, extensive hematoma removal from basal cistern has been effected during acute stage aneurysm operation. However, not all blood clot could be removed from cisterns which were remote from operation entrance, as well as from subarachnoid spaces covering the brain surface. Therefore, it is vital to wash out the blood and its brake-down products via cisternal drainage post-operatively. During past two years, we have performed 27 aneurysmal operation within four days following aneurysmal rupture. Among them, we performed post-operative cisternal drainage in 16 patients. Following removal of cisternal blood clot, cisternal drainage was performed from carotid cistern and Sylvian fissure (Group A; 4 patients). Following removal of cisternal blood clot, Liliequist's membrane was opened and clot was also removed from the intercrural cistern. If sufficient amount of CSF flowed out of the basal cistern, cisternal drainage was performed (Group B, 7 patients). If sufficient amount of CSF did not come out of the basal cistern, third ventriculostomy was effected perforating a small opening on the midline of the lamina terminalis, and then cisternal drainage was performed (Group C; 6 patients). According to the total amount of drained CSF during 6-8 days post-operatively (80-2500ml), drainage effect was divided into 3 categories; fair (more than 501ml), moderate (301-500ml) and poor (less than 300ml). In group A, 3 out of 4 patients were poor and no fair was included. However, 4 out of 7 in group B, and 3 out of 6 in group C were fair. Only one poor was included in each group B and C. The symptomatic vasospasm occurred in 37% of all 27 patients. No symptomatic vasospasm occurred in patients with mild cisternal hematoma on CT scan. In patients with moderate to marked cisternal hematoma on CT image, symptomatic vasospasm occurred in 43, 60, 100% of patients whose drainage effect was fair, moderate, poor, respectively. Thus, when hematoma in basal cistern is moderate to marked on CT image, Liliequist's membrane is opened and intercrural hematoma is removed. If sufficient amount of CSF does not flow out of the basal cistern, third ventriculostomy is effected and then cisternal drainage is performed from the carotid cistern and Sylvian fissure.
The Japanese Society on Surgery for Cerebral Strokeの論文

25. 破裂脳動脈瘤急性期手術における脳槽ドレナージュに関する一考察

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