Bipolar irrigation systemによる破裂脳動脈瘤術中radical clot removalの脳血管攣縮予防効果

Intraoperative Radical Clot Removal Therapy Using a Bipolar Irrigation System for Prevention of Cerebral Vasospasm Following Subarachnoid Hemorrhage

Ⅰ．はじめに

　くも膜下出血後の脳血管攣縮に対しては様々な対策があり，各施設で独自の工夫がなされている．代表的なものとしては，術中t-PA洗浄^1,7)，術後ウロキナーゼ脳槽洗浄^6,10)，fasudil hydrochloride¹¹⁾，ozagrel sodium¹²⁾などの薬剤，triple H療法⁸⁾などが挙げられる．当施設では過去5年間早期手術，術後2週間nicardipineおよびfasudil hydrochlorideの投与を基本としてきた．

　そのうちで術中にbipolar irrigation systemを使用してくも膜下血腫のradical removalを行ったグループと，通常の用手的洗浄によるclot removalのみを行ったグループに分け，両者での脳血管攣縮発生率，予後について比較検討した．

To investigate cerebral vasospasm following subarachnoid hemorrhage (SAH),65 cases were analyzed by the incidence of delayed ischemic neurological deficit (DIND).

　Eighty-four consecutive cases,who underwent surgery within 72 hours of SAH,were retrospectively analyzed. Sixty-five of these patients had diffuse subarachnoid hemorrhage in CT scan and had aneurysms of the anterior circulation. They were divided into two groups according to the operative procedure: Group A (35 cases) had radical clot removal therapy with urokinase in 5％ glucose solutions using a bipolar irrigation system; Group B (30 cases) had conventional clot removal using manual irrigation. There were no significant differences between these two groups for age or pre-operative WFNS grade. The incidence of DIND was 17.1％ in group A and 40.0％ in groupB; this was a significant difference. Radical clot removal therapy was effective in preventing DIND due to vasospasm.