破裂脳動脈瘤に対する早期手術の適応について

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Intentionally delayed surgical intervention to subarachnoid hemorrhage due to recently ruptured intracranial aneurysm certainly lessens morbidity and mortality. However, this kind of treatment with conventional.antifibrinolytic or other medical agents does also jeopardize patient's life expectancy in a case of recurrent bleeding. Between these two contradictory factors a surgeon should make his own choice of treatment to each case of subarachnoid hemorrhage in the early stage. Eighty consecutive cases of intracranial aneurysm were treated with consistent policy that any patient should be operated on as soon as possible whenever surgery being indicated and following results were obtained; 1) Surgery for intracranial aneurysm which was performed within the first 10 days after subarachnoid hemorrhage should be termed "the early stage operation" and sustained significantly different meaning for patient's prognosis. 2) According to Hunt & Hess's classification Grade I to III patients could be operated in the early stage regardless the location of the aneurysm or past episodes of subarachnoid hemorrhage. 3) Internal carotid aneurysm could be operated even when carotid angiogram showed angiospasm. 4) In the case of anterior communicating aneurysm surgery should be refrained until 11th day when it was graded as III since mortality was markedly decreased after 10th day. 5) When patient remained in grade IV or V longer than 2 'weeks there was no sense to wait the timing of surgery and it was advised to perform surgery whenever patient showed evidence of recovering consciousness.
The Japanese Society on Surgery for Cerebral Strokeの論文

破裂脳動脈瘤に対する早期手術の適応について

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