48.急性期clot evacuationの意義:-脳血管攣縮は予防できるか?-

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The effect of subarachnoid clot evacuation for the prevention of vasospasm (VS) in the acute stage was studied using 121 ruptured IC, MC and A co aneurysm cases. All cases were admitted within 3 days after the onset. Cases with intracerebral hematoma, a morbibund appearance or with a troubled operation were not included in this study. Operative procedure and extent of subarachnoid clot evacuation were as follows. In IC and MC aneurysms, extensive clot evacuation from proximal portion of M2, entire M1 and proximal portion of A1 to prepontine cistern by opening Liliequist's membrane were done by the transsylvian approach. But, minimal clot removal necessary for neck clipping were sometimes done in IC and MC aneurysms. In A co aneurysms, clot removal only around the A co complex were our routine procedure by the interhemispheric approach. Extensive clot evacuation by transslyvian approach from proximal portion of M2 to prepontine cistern within 48 hours after the onset did not prevent development of VS but might reduce the severtiy of VS. But, this tendency was not significant statistically. Complications of excessive clot evacuation applied to the angry, swollen brain in the acute stage were identified in 4 cases. These were worsening of the brain swelling, formation of an intracerebral hematoma and an infarction of the territory of perforating artery due to too much brain compression or injury to small veins and perforating arteries. The extent of clot evacuation should be determined by the brain's condition during the operation.It must not be done to worsen the brain's condition by the excessive clot evacuation in the acute stage.
The Japanese Society on Surgery for Cerebral Strokeの論文

48.急性期clot evacuationの意義:-脳血管攣縮は予防できるか?-

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