虚血症状を呈した破裂脳動脈瘤の手術適応

Abstract

We report 2 cases of cerebral aneurysm associated with symptomatic and angiographical cerebral vasospasm that were operated upon. The first case was hospitalized at 8 days after initial subarachnoid hemorrhage (SAH). Computed tomography (CT) revealed a low density area in the parietal lobe. A preoperative cerebral blood flow (CBF) study demonstrated low flow area corresponding to the low density area on CT.The second case was hospitalized at 5 days after initial SAH. CT revealed no abnormal findings, although the patient showed slight hemiparesis and a deterioration of consciousness level. A preoperative CBF study demonstrated a low flow area with poor reactivity to acetazolamide (AZ) loading that correporided to angiographic vasospasm.The surgery in these cases was performed at the 9 days and 6 days after SAH, respectively. The global CBF in the first case increased after surgery and intra-arterial injection of papaverine. The second case resulted in huge cerebral infarction corresponding to the low flow area with poor reactivity to AZ loading following surgery, and was refractory to intra-arterial injection of papaverine.We discuss the usefulness of CBF studies, including those with AZ loading, to determine the surgical indication.