46. 破裂脳動脈瘤早期手術例術後の脳室

概要

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During the last two years (1981-1982), we experienced 105 cases of early operation for verified intracranial ruptured aneurysms. We made a new ventriculo-cisternal irrigation system for the purpose of washing away subarachnoid clots and diluting vasospasmogenic substances. The pathway of CSF during irrigation was confirmed by RI cisternography injecting <SUP>111</SUP>In DTPA 1 mCi into the lateral ventricle.<BR>We applied this system to 25 cases in the 105 cases. In Grade III and W cases (Hunt & Kosnik) operated upon within 3 days after SAH (onset day=1st day), delayed ischemic deficit (DID) was found 36% and good and excellent cases were 64.3% of 14 cases with irrigation. DID was found 51.3% and good excellent cases were 30.8% of 39 cases without irrigation. Mortality rate was 21.4% with irrigation and 56.4% without irrigation. We measured the amount of fluid washed out and the concentration of Hb in 9 cases, and found that by this system about 30ml of whole blood was eliminated from subarachnoid space within 1 week in case of mild SAH, about 80ml in case of severe SAH.<BR>This new ventriculo-cisternal irrigation system is safe and effective to prevent vasospasm and improve the prognosis of ruptured aneurysms.