クモ膜下出血後のV-A (or P) shuntの意義について

概要

論文の詳細を見る
The authors reported the clinical results of the application of the ventricular drainage to the patients suffered from acute or subacute hyperintracranial pressure caused by ruptured intracranial aneurysms. Concerning the patients with ruptured aneurysms we have a prototype of the methods of treatment as follows: (1) After admission to the hospital all patients are isolated in ICU and they are under mild sedation with either parenteral or oral administration of barbiturates or minor tranquilizers. (2) If hypertention could not be lowered by the above mentioned treatments, reduction of blood pressure is attained by the administration of appropriate amounts of antihypertensive drugs such as chlorthiazide or methyl dopa (Ransohoff). (3) Antifibrinolytic agents such as trans-AMCHA (at least 10gm/day) are administered intravenously or orally to all patients. (Mullan). (4) Evacuation of intracerebral hematoma is urgent if angiographic study revealed the presence of hematoma. (5) In principle, direct surgical treatment of aneurysms is intentionally delayed until patients recover to Grade I or II under conservative treatment. In this series, we have 10 cases of the ruptured aneurysm without hematoma. All of these patients developed moderate or marked increased intracranial pressure with or without internal hydrocephalus. According to the classification originally designed by Hunt and Hess these patients belonged to Grade III and IV. Ventricular drainage was carried out to all of these patients utilizing either V-P or V-A shunt. It has been known that immediate benefit of the shunt-operation was the improvement of nuchal rigidity within 2 to 3 days after surgery. Consciousness level and other neurological signs started also to improve within a week thereafter. As soon as neurological status became improved, reexamination of angiography was performed in several cases. It is only our impression that when patients showed improvement of neurological symptoms, angiospasms seen in angiogram were improved comparing with our other cases experienced formerly. In the limited number of our series presented here, no deteriorative complication such as rerupture of aneurysm occurred during and after surgery. Finally we should mention our experimental study on the dogs concerning the correlation between intracranial pressure and blood pressure of circle of Willis. High intracranial pressure was produced by cerebral compression induced by inflating epidural balloon. In this situation,if intracranial pressure lowered by deflating balloon, simultaneous reduction of blood pressure in circle of Willis occurred. This seemed to be reflected by the reduction of peripheral vascular resistance of cerebrum after the deflation. According to these experimental results, it seems that reduction of intracranial pressure by ventricular drainage in cases of subarachnoid hemorrhage may have similar effect to the cerebral vascular hemodynamics of the patients. That is, this surgical intervention might not evoke the possibility of rerupture of aneurysms.
The Japanese Society on Surgery for Cerebral Strokeの論文

クモ膜下出血後のV-A (or P) shuntの意義について

スポンサーリンク

概要

著者

関連論文

スポンサーリンク