破裂脳動脈りゅう直達手術の現状

Abstract

Surgical outcome of 905 ruptured intracranial aneurysms were retrospectively analyzed in relation to presurgical Hunt and Kosnik's clinical grade, location of aneurysm, timing of surgery and patient's age. Causes of poor outcome were also analyzed in the cases with unfavorable outcome. Seven hundred nine cases had good outcome and 196 cases had poor. Presurgical poor grade resulted in unfavorable outcome; about one third of grade III and two thirds of grade IV had poor outcome. Cases who underwent early surgery tended to have poor outcome, because of more cases with poor clinical grade. Aged patients had worse result, because of poorer grade and of worse result in grade I, II and III than young patients. In 196 cases with poor surgical result, primary brain damage (PBD) was the most often (45.9%) cause of poor outcome, and vasospasm (VS) was the second (28.1%). PBD was the major cause of poor result in grade IV and V; VS was so in grade II and III. In vertebrobasilar aneurysms brain damage from surgical procedure sometimes resulted in poor outcome. Early surgery and enough treatment for vasospasm are recommended for ruptured aneurysms. Surgical outcome of elderly patients and cases with poor presurgical clinical condition should be improved.