高齢者破裂脳動脈瘤の治療方針

Managcment of Elderly Patients with Aneurysmal Subarachnoed Hemorrhage

I．はじめに

　本邦に於ける脳血管障害による死亡は1951年以来死因として1位を占めていたが，1970年の175.8（人口10万対）をピークに徐々に減少し，1981年には2位，1985年には悪性新生物，心疾患に続き3位となった．しかし，これは主に脳梗塞，脳出血による死亡の減少によるものであって，脳動脈瘤の破裂による死亡は決して減少しておらずむしろ増加する傾向にあり，今後人口の高齢化とともに高齢者の破裂脳動脈瘤患者を診る機会が増えると思われる^13）．しかし，実際に高齢者の症例を目の前にしても，治療方針，特に，手術時期に関して苦慮することが多いのが現実である．高齢者を何歳以上にするかは，時代によって異なるが，ここでは70歳以上を高齢者と定義し，自験例の検討から，高齢者破裂脳動脈瘤症例の治療方針を検討する．

Clinical features of 61 elderly patients aged over 70 years with ruptured intracranial aneurysms were com-pared with those of 328 younger patients aged under 70 years. According to a policy of early operation, elderly patients with Hunt and Kosnik's grade I, II and youn-ger patients with grade I, II, III were operated on in the acute stage. In elderly patients with grade III, IV and younger patients with grade IV, the indication for surgery was determined case by case. Surgery was per-formed on 29 patients (48%) in the elderly group and 277 patients (86%) in the younger group. Our conclu-sions are as follows :

1. Regarding cases of grade I, II and III of Hunt and Kosnik's classification, the rate of good outcome in the elderly group was similar to that in the younger group, following early surgery and meticulous post- operative care.

2. In the elderly group, no patient in cases of grade IV obtained good surgical outcome.

3. Symptomatic vasospasm was less frequent in elderly patients (18.8%) than in younger cases (37%).

4. Delayed operation was planned for some patients in the elderly group, but none of them underwent surgery because of rerupture of aneurysms and de- terioration of general condition.