破裂脳動脈瘤の早期手術

EARLY OPERATION OF RUPTURED INTRACRANIAL ANEURYSMS

緒言

　脳動脈瘤の治療に関しては，頭蓋内直接手術による動脈瘤柄部の処置が最もよい方法であることは，前に我々の254例の詳細な予後調査によつても明らかなことと考える^1）。しかし，その頭蓋内直接手術の手術時期については，現在，破裂後早期には手術を行なうべきではないとする考えがあり^3）4），なお多くの問題が残つていると思われる^9）。

　Locksley^2）によると，脳動脈瘤破裂発作後の死亡はその初期にきわめて高く，3週間以内で全死亡例の67％が死亡し，全再出血例の62％が初回発作の3週間以内に起こつているとしている。

The total number of the intracranial aneurysms experienced in our clinic was 434 cases until the end of December, 1970. In these cases, 385 cases were performed the intracrenial direct opetion and the surgical mortality rate during hospitalization was 7.8%.

A series of 107 cases as early operation's cases, which direct operation was performed within 21 days after the last episode of SAH were picked up.

The surgical mortality rate in early operation was definitively worse than in delayed operation, especially within 7 days. However, the period of operation was not the direct factor related to the operative result.

As to the operative results, the most important factor was the progress of state of patient's cousciousness.

Age, blood pressure, site of aneurysms, motor disturbance, cranial nerve disorder and preoperative vasospasm, respectively were not so important factors for the result of early surgical operation.

However, meningeal irritation and frequency of rupture of aneurysms were important factors.

Finally, as a policy for the management of rup-tured intracranial aneurysms, we emphasize that the early direct operation for the intracranial aneurysms should be done positively, if the state of patient's coucsiousness is not in coma, or in a down hill course.