72. 遅発性脳血管攣縮の病態と機能的可逆性:-血管平滑筋筋放電による術中判定の試み-

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The authors have reported that the appearance of electromyogram (EMG) of vascular smooth muscle reflects histological changes of vascular wall in bovine cerebral artery. The present study makes a comparative examination of the appearance of vascular EMG by administration of human fresh blood, histological findings of the vascular wall and the degree of vasospasm and its duration using human cerebral artery gained at autopsy (1). Furthermore, the correlation between the appearance of vascular EMG during operation and the degree of vasospasm on the pre-surgical angiograms in the ruptured aneurysm cases (2).<BR>The result was as follows: (1) In the 13 cases which died of non-SAH diseases, vascular EMG showed burst or sporadic appearance except for 2 cases with severe arteriosclerosis. In the 14 cases which died of vasospasm following SAH, electrical discharge was not recognized in 9 cases with marked myonecrosis of vascular wall. Vascular EMG could be detected in cases which died within 1 week from the appearance of vasospasm or in cases which shows local narrowing on the angiogram, and corresponded to the degree of the myonecrosis of the vascular wall. (2) In 9 SAH cases and 1 non-SAH case which showed no narrowing on the angiogram, spontaneous discharge was well recognized and the frequency of discharge increased on the thermic stimulation by injecting of 20°C and 40°C physiological salt solution. But in 5 cases of severe diffuse narrowing and 4 cases of irregular narrowing, no electrical discharge was observed with no response to thermic stimulation. Appearance of vascular EMG was well consistent with the degree of narrowing on the pre-surgical angiogram.<BR>The appearance of vascular EMG corresponds to the degree of organic change of the vascular wall in human cerebral artery. The induction of vascular EMG during operation can anticipate the functional reversibility of the vessel with vasospasm and play a role as the index for selecting treatment such as vasodilator, induced hypertension, hypervolemia, etc..
The Japanese Society on Surgery for Cerebral Strokeの論文

72. 遅発性脳血管攣縮の病態と機能的可逆性:-血管平滑筋筋放電による術中判定の試み-

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