High Score SAH に対する種々の外科的治療法の成績比較

Abstract

The incidence of cerebral vasospasm and results were analized in 257 patients with high scored SAH (Fisher's Group 3) in a multicenter study. Patients were divided into three groups according to surgical principles: “conventional surgery” in the acute stage, “scavenger surgery” (active subarachnoid clot removal) and “delayed surgery” (wait until the later stage). A subgroup analysis was made on cerebrospinal fluid drainage and on irrigation with urokinase. Symptomatic vasospasm was the lowest in the “scavenger surgery” group with a statistical difference (p<0.01) between it and the“conventional surgery”.Severe cerebral infarction was decreased by active clot removal. The excellent result increased from 39% to 54% by clot removal in the acute stage. Postsurgical CSF drainage or irrigation with urokinase was effective when they were combined with “scavenger surgery”, but not with “conventional surgery”. Surgical complication caused by clot removal was only 5.4%. In the “delayed surgery” group, more than 60% of the patients died without the chance for surgery. It was concluded that active subarachnoid clot removal with postsurgical drainage or irrigation could offer a remarkable improvement of results by its prophylactic effect on vasospasm in patients with severe subarachnoid hemorrhage.