破裂脳動脈瘤の急性期における手術適応の決定:-梗塞源性クモ膜下出血について-

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It is a well-known fact that the mortality rate of rebleeding in the case of the ruptured cerebral aneurysm is mu2h higher than that of the initial bleeding, but there remains many enigmas as to the reasons about it. On the other hand, the causes of so-called rebleeding have been considered to be 1) the re-rupture of the aneurysm, 2) the bleeding from the second one of multiple aneurysms, and 3) the bleeding from the concurrent cerebral or spinal disease e.g, brain tumor etc. ; among these, the re-rupture is generally presumed to be the most frequent.<BR>We postulate that, as a cause of rebleeding other than these, the hemorrhagic infarction of the brain attributable to the vasospasm and or vascular stenosis after the initial bleeding is not uncommon and of greater importance in regard to the so-called rebleeding, and that the infarction encroaching upon the teritories of perforating arteries is the major cause of death. In other words, reappearance or increase in grade of the subarachnoid hemorrhage (SAH), which is usually called "rebleeding", is the omnious sign of the life-threatening hemorrhagic infarction.<BR>Since the direct operation for the cerebral aneurysm is almost perfectly established in the technical problem especially in the field of microneurosurgery, the cerebral vasospasm and infarction are the last and most important problems remaining to be resolved in respect to the treatment and prevention.
The Japanese Society on Surgery for Cerebral Strokeの論文

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稲葉穣
東京医科歯科大学脳神経外科

破裂脳動脈瘤の急性期における手術適応の決定:-梗塞源性クモ膜下出血について-

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