44. 破裂脳動脈瘤急性期手術時の迂回槽, 四丘体槽開放ならびに灌流の脳血管攣縮に対する検討

概要

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Although the effectiveness of the operation of ruptured cerebral aneurysm within 48 hours after bleeding has been reported, some cases result in failure on account of post-operative vasospasm. In our clinic, 46 cases underwent the operation of cerebral aneurysm within 48 hours; of these 10 cases became worse after recovery of consciousness. In these patients the CT scan showed remarkable high density areas within the ambient and quadrigeminal cisterns.<BR>On the basis of our data, we have investigated the effectiveness of the active removal of subarachnoid clot and the irrigation during operation so as to improve the clinical results of serious cases.<BR>After neck clipping of cerebral aneurysm, the clot in Sylvian fissure and the basal cistern is removed as much as possible. In the serious cases, a drain is inserted into the interpeduncular cistern and the edge of the tentorium is excised after retracting the temporal lobe. The clot in ambient-quadrigeminal cistern is removed and then a drain is inserted. Drainage is performed from the interpeduncular cistern following the injection of physiological saline to the ambient-quadrigeminal cistern.<BR>Of 6 cases in this series, 3 did not have vasospasm. And the degree of vasospasm which was recognized in 2 seemed to be reduced.
The Japanese Society on Surgery for Cerebral Strokeの論文