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Neurological Surgery No Shinkei Geka Volume 35, Issue 10 （October 2007）

Neurological Surgery 脳神経外科 35巻10号（2007年10月発行）

Japanese English

研究

八重山諸島における脳動脈瘤破裂によるくも膜下出血（1989～2002） Aneurysmal Subarachnoid Hemorrhage in the Yaeyama Islands, Japan, from 1989 to 2002 泉原昭文 ¹ , 下地隆 ² , 上杉政司 ² , 藤澤博亮 ³ , 鈴木倫保 ³ , 伊江朝次 ⁴ Akifumi IZUMIHARA ¹ , Takashi SHIMOJI ² , Masashi UESUGI ² , Hirosuke FUJISAWA ³ , Michiyasu SUZUKI ³ , Tomoji IE ⁴ ¹国立病院機構関門医療センター脳神経外科 ²下地脳神経外科 ³山口大学医学部脳神経外科 ⁴沖縄県立八重山病院外科 ¹Department of Neurosurgery, National Hospital Kanmon Medical Center ²Shimoji Neurosurgical Clinic ³Department of Neurosurgery, Yamaguchi University School of Medicine ⁴Department of Surgery, Okinawa Prefectural Yaeyama Hospital キーワード： subarachnoid hemorrhage , cerebral aneurysm , epidemiology , subtropical region , isolated island Keyword: subarachnoid hemorrhage , cerebral aneurysm , epidemiology , subtropical region , isolated island pp.987-994

発行日 2007年10月10日 Published Date 2007/10/10

DOI https://doi.org/10.11477/mf.1436100627

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Ⅰ．はじめに

　八重山諸島は日本列島の最南西端に位置し，石垣島を中心に32の島（12の有人島）から構成されている．亜熱帯海洋性気候に属し，温暖で1年間の気温変化が小さく，台風の接近が多いという特徴をもっている．また沖縄本島から約400km以上離れた離島群であり，宮古諸島からでも約100km以上離れており，隔絶された地域となっている．今回，われわれは疫学および離島医療の観点から，八重山諸島における脳動脈瘤破裂によるくも膜下出血について検討した．

　The aim of this study was to analyze epidemiological and clinical data of patients with aneurysmal subarachnoid hemorrhage (SAH) in the Yaeyama islands, an isolated subtropical region of Japan.

　A total of 94 patients (31 men and 63 women, mean age 57.3 years) were diagnosed as having non-traumatic SAH during a 13-year period from 1989 to 2002. The age-and sex-adjusted annual incidence rate of SAH was 17.4 per 100,000 population. The incidence of SAH was the highest in August. Seventy-nine patients were hospitalized within 24 hours after onset of SAH. Seventeen patients were transferred by helicopter. The Hunt and Kosnik grade was I in 29 patients (30.9%). The CT Fisher group was 3 in 42 patients (44.7%). Ruptured aneurysm was detected in 78 patients (saccular type in 70 patients, small size in 49 patients, and internal carotid artery in 28 patients). Rebleeding occurred in 20 patients (21.3%). Symptomatic vasospasm occurred in 26 patients (27.7%). Acute and chronic hydrocephalus occurred in 25 (26.6%) and 22 (23.4%) patients respectively. A total of 120 neurosurgical operations were performed in 70 patients (operation for ruptured aneurysm in 62, early operation in 39). A total of 42 operative complications occurred in 29 patients. Fifty-one patients (54.3%) had a good outcome. The number of full-time neurosurgeons did not influence the performance of neurosurgical operation and outcome.

　In conclusion, epidemiologically, the high incidence of SAH in August is unusual. Patients with aneurysmal SAH in the Yaeyama islands have common clinical characteristics and undergo standard neurosurgical treatment.