慢性透析患者に併発した破裂脳動脈瘤に対し, 急性期手術を施行した2症例

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  • Two cases of neck clipping surgery for ruptured aneurysm in chronic hemodialysis patients

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We report two successful neck clipping surgery cases for ruptured intracranial aneurysms in chronic hemodialysis patients, a subject that has rarely been reported.<br>One case was a 50 year-old male (Hunt Grade I ), the other a 38 year-old female (Grade IV). They were diagnosed as having subarachnoid hemorrhage by brain CT scan, after which a 4 vessel study was done. Thereafter, neck clipping surgery was performed. External decompression by craniotomy, hypertonic fluid infusion and steroid therapy were performed after the operation to prevent brain edema and herniation. Post operation hemodialysis (HD) was performed daily without any anti-coagulation therapy to achieve precise fluid regulation and to avoid bleeding in the subarachnoid space. When high-sodium HD and intradialytic hypertonic fluid infusion was used to prevent a decrease in intradialytic plasma osmolarity, plasma osmolarity, intracranial pressure and consciousness level remained stable during the course of hemodialysis. Therefore, we would like to point out uselness of intradialytic plasma osmolarity regulation in addition to external decompression by craniotomy to control increased postoperative intracranial pressure. We conclude that aggressive surgical therapy for ruptured intracranical aneurysms is possible even in patients on maintenance hemodialysis.

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