破裂脳動脈瘤の早期手術:-術後脳血管攣縮を中心として-

概要

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We have already proposed a constructive direct surgery of ruptured intracranial aneurysm in early state.<BR>Some patients in good condition (Botterell gr. II-III) had a poor prognosis due to postoperative arterial spasm. In this study, we have reported the dynamic changes of vasospasm observed by repeated angiography, and clarified the significance of vasospasm in surgery of early stage.<BR>Postoperative vasospasm frequently occurred in cases which had operation within 14 days after the last attack. The poor prognosis was obtained in the cases with diffuse vasospasm in pre- or postoperative angiograms.<BR>In conclusion, when marked subarachnoid hemorrhage was observed at the time of operation, external decompression and ventricular drain-age are preferable for the brain edema due to postoperative vasospasm. If preoperative angioframs showed diffuse vasospasm, the delayed operation was advisable under constructive conservative management including the continuous ventricular drainage.
The Japanese Society on Surgery for Cerebral Strokeの論文