遅発性脳血管攣縮に対するCT値Grading, 特にFisher分類との比較

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The relationship between cisternal high density calculated by Hounsfield-number (HN) in computed tomography and subsequent development of cerebral infarction due to delayed vasospasm (VS) was studied retrospectively in 36 cases with ruptured cerebral aneurysm. All patients were hospitalized within 24 hours and operated within 48 hours after subarachnoid hemorrhage. Extensive removal of cisternal blood clots were carried out after obliteration of the aneurysm.<BR>The relation between HN in post-operative CT and VS was noted as follows. When HN was less than 68, VS did not occur in any of the cases. When HN was ranged from 68 to 73, the incidence of VS was 50%. When HN was 73 or more, VS occurred in all of the cases.<BR>In view of these results, a new grading according to HN for the incidence of VS was proposed, that is, no cisternal high density=grade I, HN of less than 68 = grade II, HN ranged from 68 to 73=grade III, HN ranged from 73 to 78=grade IV, and HN of 78 or more = grade V. This grading was very useful to decide the timing of operation and to determine the sites and degree of clots to be removed.<BR>In comparison with HN grading to Fisher's classification, the HN grade II mainly corresponded to Fisher's class II, and Fisher's class III corresponded to HN grade III to V. Thus, the HN grading was not only very precise and quantitative but it serves the purpose for prediction and protection of highly VS prone patients.
The Japanese Society on Surgery for Cerebral Strokeの論文

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藤田稠清
兵庫県立姫路循環器病セソター脳神経外科

遅発性脳血管攣縮に対するCT値Grading, 特にFisher分類との比較

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