脳動脈瘤の顕微鏡下手術の遠隔成績

FOLLOW-UP RESULTS OF MICROSURGERY OF INTRACRANIAL ANEURYSMS

I．はじめに

　脳動脈瘤の顕微鏡下手術（microsurgery）はことにわが国で普及し，いまさらこれについて云々する必要もないと思われる。「ことにわが国で」とことわつたのは，欧米ではいまだに動派瘤の手術に手術用顕微鏡は必要ないと断言している大家も少くないからである。もつともわが国でも最多動脈瘤症例数をもつ東北大学の鈴木二郎教授は顕微鏡は必要ないという主張をたびたび表明しておられる。もちろんこれら大家連の主義主張はそれはそれなりに立派であり，評価すべきものである。

　われわれの教室では1969年秋から動脈瘤直接手術はすべて手術用顕微鏡下に行なつているので1976年末で約7年間経過したことになる。（手技については別に発表した^10,11））この辺で遠隔成績をまとめて発表するのが，最初にわが国にmicrosurgeryを導入したものの義務であると思うのでこの一文を草した次第である。

In the past 7 years, 403 cases of intracranialaneurysms were submitted to microsurgical oper-ations. The operative mortality was 5.4%, and inthe follow-up, 82.4% are working, 6.2% are caringfor self and 5.9% are either bed-ridden or deadfrom other causes after discharge.

If 6 cases of Grade V are excluded from thestatistics and the day of subarachnoid hemorrhage(SAH) is counted as the 1st day, cases submittedto microsurgery on the 1st, the 2nd and the 3rddays showed no mortality and 72.7% of them areworking in the follow-up. Cases undergone micro-surgery on the 4th through the 8th day showeda high mortality of 15.2% due to postoperativevasospasm, whereas in cases submitted to micro-surgery in the 2nd week after SAH the operativemortality was 6% and in cases submitted to micro-surgery later than the 2nd week it was 3%. Inthe follow-up 84% and 85.6% are working in thelatter two respectively.

These results seem to encourage ultra-earlysurgery for ruptured aneurysm cases. However,one should always bear in mind that the acutestage of SAH should be regarded as a "systemicdisease", not as a "local disease", and only thosewho have ability and facility to manage thissystemic disease may be qualified to perform earlysurgery for ruptured aneurysms.