来院時に比べ転帰の悪化した破裂動脈瘤症例の検討

Abstract

The overall results of 217 patients with subarachnoid hemorrhage (SAH) for the past three years and 33 poor outcome patients in comparison with the grade on admission were analyzed. The sites of aneurysm in poor outcome cases were ICPC in 12 cases (36.4%), Acom in 6 cases (18.2%), MCA in 5 cases (15.2%), BAtip in 5 cases (15.2%), and others in 3 cases (9.1%). The causes of poor outcome cases were vasospasm in 11 cases (33.3%) intraoperative complication in 8 cases (24.3%), preoperative rebleeding in 6 cases (18.2%), and complication in 5 cases (15.1%).Although cisternal irrigations were performed in 9 cases in the vasospasm cases, they were not effective. The causes of intraoperative complications were perforating artery injury in 5 cases (62.5%), premature rupture, incomplete clipping, and embolization from aneurysm in 1 case (12.5%). The preoperative rebleeding rate was 31.2% in Grade 5, 27.8% in Grade 4, 10.0% in Grade 3, 11.2% in Grade 2, and 0% in Grade 1. Considering these analyses of overall management results and poor outcome cases, we suggest the following to improve the SAH outcome: 1) the development of essential therapy for the severe vasospasm; 2) the preservation of perforating artery in the operation; 3) the careful management for the rebleeding in risky period.