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Neurological Surgery No Shinkei Geka Volume 28, Issue 6 （June 2000）

Neurological Surgery 脳神経外科 28巻6号（2000年6月発行）

Japanese English

研究

脳卒中患者の急性期外科的治療の現況—特に脳梗塞について Acute Surgical and Endovascular Therapy for Stroke : especially patients with brain infarction 丹羽潤 ¹ , 久保田司 ¹ , 千葉昌彦 ¹ , 三上毅 ¹ , 岡真一 ¹ Jun NIWA ¹ , Tsukasa KUBOTA ¹ , Masahiko CHIBA ¹ , Takeshi MIKAMI ¹ , Shinichi OKA ¹ ¹市立函館病院脳神経外科 ¹Department of Neurosurgery, Hakodate Municipal Hospital キーワード： Brain infarction , acute surgical treatment , acute endovascular treatment Keyword: Brain infarction , acute surgical treatment , acute endovascular treatment pp.499-504

発行日 2000年6月10日 Published Date 2000/6/10

DOI https://doi.org/10.11477/mf.1436901898

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Abstract 文献概要
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Ⅰ．はじめに

　1985年に市立函館病院の救命救急センターに脳卒中診療部門が設立されて以来，函館市内はもとより南北海道の各施設から多くの脳卒中患者が搬送されてくる．脳出血やくも膜下出血に対する急性期外科治療はもちろんのことであるが，最近は血管内手術の進歩により脳梗塞に対しても急性期治療が行われるようになった^4,9,11）．しかしこれまで脳梗塞急性期患者に対してどのくらいの割合で外科的治療が行われているか詳細に検討された報告は見られない^13）．今回過去4年間に当院に搬入された脳卒中患者の動向と特に脳梗塞の急性期外科的治療（外科手術と血管内治療）の現状について検討したので報告する．

From January 1994 to December 1997, 845 patients with stroke were admitted to Hakodate Municipal Hospital. They consisted of 514 patients with brain infarction, 206 with brain hemorrhage, 121 with sub-arachnoid hemorrhage and 4 with intracranial hemorrhage from arteriovenous malformation. The clinical categories of brain infarction were as follows; atherothrombotic recognized in 158 patients, cardioembolic in 114, lacunar in 217 and other categories in 25.

With regard to the cures of brain infarction in the acute phase, direct percutaneous transluminal angio-plasty (direct PTA) was carried out on three patients with atherothrombotic infarction, immediate PTA on two, superselective fibrinolytic therapy on two, and STA-MCA anastomosis on three. In all, ten athero-thrombotic patients (6.3%) were treated by acute surgical or endovascular therapy. On the other hand, su-perselective fibrinolytic therapy was carried out on 35 patients (30.7%) with cardioembolic infarction. There were no patients in the lacunar infarction group who were given acute surgical treatment. Neurological improvement after 24 hours was recognized in 4 patients (40%) of 10 with atherothrombo-tic infarction, and in 9 patients (25.7%) of 35 with cardioembolic infarction. However, symptomatic in-tracerebral hematoma was recognized in 4 patients (11.4%) with cardioembolic infarction. Indication for acute surgical or endovascular treatment for brain infarction was very limited because of the time factor from the onset to admission. It is suggested that neurosurgeons might enlighten citizens about the necessity for acute surgical or endovascular therapy for stroke.