急性期破裂脳動脈瘤の術前Gradingと予後:-特にHunt-Hess分類, 3-3-9度方式, Glasgow Coma Scaleの問題点について-

概要

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In preparing for a new grading system for ruptured aneurysm, we have investigated the relationship of the preoperative grades according to various systems to the postoperative results, in 168 patients operated on within 48 hours after the last attack. The grading systems used here were Hunt-Hess system (H-H), Glasgow Coma Scale (GCS) and 3-3-9 system (3-3-9). 1. The results in 39 Grade I patients and those in 44 Grade II patients were equally excellent. 2. The GCS sum scores for 65 Grade III patients varied between 15 and 9. The results were good in patients with a GCS score of 13 or more, and were poor in patients with a GCS score of 12 or less. 3. The 3-3-9 grades for the Grade III patients were between 0 and 20. The results were good in patients in 3-3-9 grade 10, and were poor in grade 20. 4. The GCS sum scores for 18 Grade IV patients were between 12 and 6, and the 3-3-9 grades between 30 and 200. There was no clear distinction between Grade III and IV. The results in Grade IV patients were poor, however the severity of the preoperative grade was not always related to the results. It is thought that each of the three grading systems, H-H, GCS and 3-3-9, has some defects as a grading system for ruptured aneurysm, which requires us to invent a new system.
The Japanese Society on Surgery for Cerebral Strokeの論文