多発性脳動脈瘤の急性期の処置

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A 64-year-old female was admitted to the hospital on October 12, 1972. On October 11, the patient lost suddenly her consciousness for about 4 hours. Because of severe headache after regaining consciousness, she was admitted to a hospital. Spinal tap disclosed bloody CSF with opening pressure of 300mm H<SUB>2</SUB>O <BR>On admission the patient was clear. Carotid angiographies revealed symmetrical aneurysms of the middle cerebral artery, the right one being interpreted as ruptured one. Because of lowering her conscious level on the following day, direct attack was performed. At first the right temporal cranitomy was done and the ruptured aneurysm was successfully clipped. It took five and a half hours in consequence of careful dissection of the aneurysm in order to preserve the small perforating arteries. And then the unruptured aneurysm was clipped through the left temporal craniotomy. It took two hours. The patient did not awake from the anesthesia. Postoperative right carotid angiography demonstrated evidence of intracerebral hematoma in the temporal lobe. Through immediate recraniotomy 20 gm of intracerebral clot was evacuated. The right frontal lobe was removed owing to acute brain swelling. On the postoperative 3rd day recraniotomy was performed again because of developing anisocoria. Intracerebral hematoma was again removed, but hemostasis was extremely difficult because of oozing hemorrhage from the brain. The patient did not regain consciousness and died on October 16.<BR>There are 37 cases of multiple aneurysms (24%) in 152 cases of intracranial aneurysms encountered in our department. Our surgical policy for multiple aneurysms was early, one stage operation.However, when the ruptured side operation is time-consuming as shown in the present report, nonruptured aneurysm on the opposite side should be attacked separately in near future.
The Japanese Society on Surgery for Cerebral Strokeの論文

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原田範夫
岩手県立中央病院脳外科

多発性脳動脈瘤の急性期の処置

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