破裂脳動脈瘤部位別のCT所見と脳血管攣縮, 水頭症および予後との関連

概要

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Multifactorial analyses were performed on patients with early surgery (within 72 hours) for ruptured intracranial aneurysms (Hunt gr I-IV) with respect to their CT findings and prognosis. There were 68 cases of internal carotid (ICA), 65 anterior communicating (ACoA), and 53 middle cerebral (MCA) aneurysm. Over all good prognosis (Glasgow Outcome Scale: 1-2, at 6 months) was obtained in 70% of all patients. The main findings are listed as follows:<BR>1) Thick subarachnoid clot (>1mm) in quadrigeminal cistern was accompanied by high mortality rate of over 50% in ICA and MCA, while it reached 75% in ACoA.<BR>2) Delayed angiographic vasospasm was seen in 65% (ICA), 62% (MCA) and 39% (ACoA) of patients with thick SAH on CT.<BR>3) Shunt operations were necessary in 12% (ICA and MCA) and 25% (ACoA) of patients. However these values rose to 21% (ICA), 36% (MCA) and 42% (ACoA) when acute hydrocephalus (CV Index>15%) was noted on preoperative CT.