破裂脳動脈瘤の急性期における手術適応の決定

概要

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We had performed radical operations on 152 patients with cerebral aneurysms during Jan. 1, 1969 to Dec. 31, 1972. Sixty-eight cases were early operation cases, should we define early operations as those within 14 days after the last SAH. Operative indication in the early stage of SAH is a controversial one. In our department the indication has changed gradually with accumulation of our operative experiences. At first, the early operation was indicated for all the patients with ruptured aneurysms except for the cases with decerebration. As supplementary methods, decompression procedure, washing out of ventricular and lumber C.S.F., or induced hypothermia etc, were tried during and following operation. The results of our operations on 138 cases were as follows: operation within 7 days had poor results in spite of all effects above mentioned: Quality of C.S.F., and consciousness level had important effects upon the results of operation. Our policy for operation of ruptured aneurysms was changed into the new one in Sept. 1972, when P.O.B, was tried clinically in our department. 1. Radical operation is indicated after 14 days of the last SAH. Early operation is indicated on the following cases; (1) with intracerebral or intraventricular hematoma, and with possibility of life-saving by evacuation of the hematoma (without radical procedure of the aneurysm).
The Japanese Society on Surgery for Cerebral Strokeの論文