CTによる破裂脳動脈瘤の診断と病態分析

Diagnosis and Pathological Analysis of Ruptured Cerebral Aneurysm by CT

Ⅰ．はじめに

　1972年Hounsfieldにより発表されて以来のCT scan　（以下　CT）の普及はめざましく，今日ではCTのない脳神経外科の診療は老えられない程重要な補助検査法となり，破裂脳動脈瘤におけるCTの意義も強調されつつある^{6,11,12,17,21）}．

　一方，近年の手術用顕微鏡の普及で，脳動脈瘤の直達手術の成績は飛躍的に向上した．しかしこの直達手術は，術前Gradeの不良例，手術時期の選択，くも膜下出血に続発する脳血管攣縮や脳梗塞，あるいは髄液循環不全に伴う急性脳室拡大，正常圧水頭症など検討すべき幾多の問題をかかえており，その病態解明が治療方針の選択に直結すると考えられる^1,11）．

This report describes the analysis of 216 CT pictures of 85 patients with ruptured aneurysms which consist of 29 anterior communicating, 27 internal carotid, 27 middle cerebral and 2 basilar arterial aneurysms, including 18 cases with multiple aneurysms. The intervals between CT scanning and the last subarachnoid hemorrhage were various from 6 hours to 4 months.

The first CT scanning was made in 40 cases within 3 days, in 54 cases within 7 days and in 11 cases more than one month after the hemorrhage.