破裂脳動脈瘤，非手術死亡例の検討

POSTMORTEM EXAMINATION OF PATIENTS WITH NON-SURGICALLY TREATED RUPTURED ANEURYSMS

I．はじめに

　破裂脳動脈瘤の治療において，外科的根治手術の必要性は，今日広く認められている。東北大学脳神経外科では，1975年9月末日までに，1,000例をこえる破裂脳動脈瘤症例を経験している。本報は，これら症例の中で外科的根治手術を施行されることなく，入院中に死亡した症例を検討し，脳動脈瘤破裂後，natural historyにおける死亡原因を明らかにし，さらにこれら死亡症例の外科的根治手術による救命の可能性について考按を加えた。

There is no doubt that radical surgery has been successful in preserving the lives of patients with ruptured aneurysms. On the other hand, no matter how successful we have been we cannot and must not forget the patients who died without under-going surgery. Therefore, we investigated from clinical course, laboratory work, including angio-graphy and autopsy, 38 cases who died during hospitalization in order to elucidate the causes of death in the natural course and to find the possi-bilities of minimizing the number of non-operative fatalies. We classified the causes of death into 3 groups: intracranial hemmatomas, brain ischemia due to vasospasm, and aggravation of the general condition.

From the study, it was concluded that most of the lives could have been saved, if appropriate diagnosis and treatment had been made as soon as possible after the initial hemorrhage.