脳動脈瘤急性期手術後の脳血管攣縮に対する治療 : -持続脳槽ドレナージとアルブミン投与およびHypertensive/Hypervolemic Therapyについて-

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Long-term functioning enhanced cisternal drainage was performed, in aneurysmal early stage operation after SAH, to effect continuous wash-out of the subarachnoid blood clot postoperatively.<BR>Thirty-eight patients with Hunt and Kosnik (H & K) clinical Grade I-III who underwent aneurysmal neck clipping within 4 days after SAH were analyzed. Following extensive removal of the cisternal blood clots, the Liliequist's membrane was opened widely to remove clots from the interpeduncular cistern. If sufficient amount of CSF did not come out, third ventriculostomy was effected by making a small hole on the midline of the lamina terminalis. Then, drainage was performed from the carotid cistern. Depending on average amount of drained CSF per-day, drainage effect was divided into poor, moderate and fair groups. Only 2 patients with the enhanced cisternal drainage showed poor drainage effect. SAH was graded into 0-III depending on the amount of cisternal hematoma on admission CT. No symptomatic vasospasm occurred in patients with Grade I of H & K clinical as well as SAH gradings. In patients with Grade II+III of H & K clinical grading, the symptomatic vasospasm occurred in 44, 60 and 36% of patients with poor, moderate and fair drainage effect, respectively. In patients with Grade II+III of the SAH grading the symptomatic vasospasm occurred in 78, 60 and 42% of patients with poor, moderate and fair drainage effect, respectively. Nine patients with symptomatic vasospasm were treated by the hypertensive/hypervolemic therapy (HHT). The HHT was not successful in all 2 patients with poor drainage effect. One year after discharge, patients prognosis was evaluated by the Glasgow Outcome Scale (GOS). Six patients slightly disabled, one severely disabled, another one died. Remaining 30 patients (79%) of“good recovery”were analyzed on the drainage effect depending on the H & K clinical and SAH gradings. The good recovery was found in 63, 100 and 86% of patients with poor, moderate and fair drainage effect in Grade II+III of H & K clinical grading, respectively as well as in 33, 100 and 83% of patients with poor, moderate and fair drainage effect in Grade II+III of SAH grading, respectively.<BR>Thus, the post-operative long-term functioning enhanced cisternal drainage could reduce incidence of vasospasm and gain effect of HHT, and benefit to the outcome of the early aneurysmal operation.

脳動脈瘤急性期手術後の脳血管攣縮に対する治療 : -持続脳槽ドレナージとアルブミン投与およびHypertensive/Hypervolemic Therapyについて-

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