広範なくも膜下および脳内血腫の除去が重症くも膜下出血の治療に果たした役割

Abstract

We have retrospectively analyzed outcome for poor-grade aneurysmal subarachnoid hemorrhage (WFNS Grade IV-V) among consecutive 24 and 36 patients in two periods: 1993.7-1994.6 and 1998.7-1999.6, respectively. In both periods, we aggressively treated them with early surgery, including extensive surgical removal of subarachnoid clot and intracerebral hematoma using a high-pressure irrigation-suction system. In the second period, hematoma removal could be achieved less invasively and more extensively with technical improvements and usage of urokinase in the irrigation fluid. More patients in their 70s and 80s were treated surgically in the second period. When all patients were compared, the rate of favorable outcome increased in the second period but not significantly. However, among patients less than 80 years old, patients with 6-9 points in preoperative Glasgow Come Scale (GCS) and the WFNS Grade IV patients with Fisher 4 CT achieved a significantly better outcome in the second period. In both periods, patients in their 80s and patients with 3-5 points in preoperative GCS did not show any improvement in overall outcome. Extensive treatment, including extended removal of subarachnoid clot and intracerebral hematoma, helped improve the patients described above, but did not change the overall outcome because of the increased number of older patients and patients in worse grades in the second period.