45. 重症破裂脳動脈瘤症例に対する脳底槽反復洗滌法併用の検討

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Since 1978, we started the trial of the ultra-early operation and the additional repeated cisternal irrigation for the severe subarachnoid hemorrhage, namely intracranial aneurysm of grade 4 and 5, in order to prevent the later complication of vasospasm. In these 4 years, 148 cases of intracranial aneurysm were admitted in our hospital, in which 57 cases belonged in grade 4 and 5 (39%). In these severe cases, surgery was indicated for 38 cases and other 19 cases were not indicated for surgery. In the operative results in 38 cases, 9 cases recovered to ADL-1, 8 cases returned to ADL-2, 3 cases to ADL-5 and 15 cases died. Results of non-operative cases were miserable, or all died except one case.<BR>Repeated cisternal irrigation was adopted in 17 cases of the operative group and as the results, 6 cases of them recovered to ADL-1, 2 cases to ADL-2, 3 cases to ADL-5 and 6 cases died; in other words, results were divided clearly into the effective group and the non-effective group.<BR>On the investigation from the daily diminution of CT number of the basal cisterns, the following characteristic evidence became apparent in each group. 1) In non-operative cases, the daily diminution of CT number was minimal even until 6 days after the hemorrhage and the density was more than 1.5 times higher than the control brain tissue. 2) In the irrigation effective cases, the density was decreased to less than 1.5 times of the control until 3-6 days after the hemorrhage. 3) In the irrigation noneffective cases, the density was once decreased remarkably after the operation but it remained in the level of more than 1.5 times higher than the control.
The Japanese Society on Surgery for Cerebral Strokeの論文

45. 重症破裂脳動脈瘤症例に対する脳底槽反復洗滌法併用の検討

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