破裂脳動脈瘤急性期手術の問題点:-CT所見と脳血管攣縮の関係-

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Table 1 shows 239 cases of ruptured intracranial aneurysm which admitted to the Iwate Prefectural Central Hospital. CT findings were graded from I to V as follows (Fig. 1), Grade I: No abnormality or isodensity in CT findings. Grade II: High density area only in the cistern in which the ruptured intracranial aneurysm exists. Grade III: High density areas also in cisterns other than that in which the ruptured intracranial aneurysm exists. Grade IV: Symmetrical extremely high density areas in all cisterns. Grade V: Presence of massive intracerebral or intraventricular haematomas. With respect to distribution of ruptured cerebral aneurysms and CT findings, comparisons were then made of the morbidity and mortality rates between the 115 cases (Group A) operated on within 3 days of SAH and 72 cases (Group B) operated on 4 or more days afterwards. The mortality rate was 13.9% in Group A and 2.7% in Group B. The morbidity rate was 22.6% in Group A and 30.5% in Group B (Table 2,3). Among the 52 fatal cases not operated on, 11 patients died from rebleeding while waiting for operation and 6 from vasospasm, which would have been Grade II-III according to Hunt-Kosnik's criteria, the patients lives were saved because of operations being performed within 3 days. Combining these cases, the mortality rate for those waiting for operations was 21.3%. The remaining 35 of these 52 fatal cases were inoperable with Grade V of Hunt-Kosnik. Correlation between CT findings and Grading of Hunt and Kosnik shows that death from postoperative vasospasms and brain edemas occurred in ten of 31 cases with Grade IV of CT finding. All these ten cases would have been classified as Grade II or III according to Hunt and Kosnik's criteria in early surgery (Table 4). So, grading based on CT findings are more useful in predicting postoperative results than Hunt and Kosnik's gradings.

破裂脳動脈瘤急性期手術の問題点:-CT所見と脳血管攣縮の関係-

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