未破裂脳動脈瘤の外科手術の合併症とその対策―慢性硬膜下血腫および後頭蓋窩出血の発生予防―

Abstract

Postoperative chronic subdural hematoma (CSH) and remote cerebellar hemorrhage (RCH) is one of the important complications for treatment of unruptured intracranial aneurysm. The purpose of this study was to determine how to prevent CSH and RCH following the treatment of unruptured intracranial aneurysms. Between January 2000 and December 2007, 290 patients underwent clipping for unruptured intracranial aneurysms at our institution. We studied the patient's age and sex, location, size and multiplicity of aneurysm, the craniotomy site, the operative time required, operator and the procedure and the methods of anesthesia. We also reviewed the findings and outcomes of CSH and RCH. The incidence was 4.4% (males, 9.5%; females, 2.9%) and the mean age was 65 years with CSH. The incidence of RCH was 6.0% (males, 6.8%; females, 5.8%) and the mean age was 59.5 years. There was no statical significance in the occurrence of CSH or RCH in location, size and multiplicity of aneurysm or the operative time required. RCH occurred in 4.4% of cases using inhalation anesthesia, and 7.2% in total intravenous anesthesia, respectively. There was no evidence of associated morbidity in any of the cases. CSH occurred predominantly in male patients over 65 years old. The risk of RCH was intraoperative draining of large volumes of CSF, total intravenous anesthesia with mannitol use and postoperative drainage of larger amounts of fluid. The results showed the importance of careful operative procedure and the effectiveness of arachnoid plasty in preventing CSH and RCH.