Has the Treatment for Ruptured Intracranial Aneurysms been Established?

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  • 破裂脳動脈瘤は解決されたか
  • From Results During the Last One Year
  • 最近1年間の成績より

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To investigate the overall and surgical management results in cases with aneurysmal subarachnoid hemorrhage (SAH), 75 consecutive patients who were admitted to our institute during the last 1 year (1993.11.-1994.10) were retrospectively analyzed compared with the results of the past 20 years (1973.11.-1993.10.). It was revealed that the percentage of the aged patients and the poor-graded patients was increasing. Fifty-seven patients (76.0%) received direct surgery for the ruptured aneurysms and 48 cases (84.2%) were operated on within 3 days after the attack. Overall, 46 (61.3%) patients exhibited a good recovery at discharge and 13 (17.3%) had died, while from the results of the past 20 years the rate of good recovery was 52.9% and dead was 27.4%. From the surgical results of the last 1 year the rates of good recovery and dead were 74.5% and 3.6% respectively, and 66.8% and 10.5% respectively for the past 20 years, showing that have certainly improved, especially in the younger (<70 years old) group. The main causes of poor outcome (severe disability and dead) were the direct effect of initial insults (63.2%), rebleeding (10.5%), high age (21.2%), and technical complications (5.3%). Our therapeutic protocol for vasospasm, including continuous cisternal drainage, intrathecal injection of urokinase, continuous intravenous injection of nicardipine and dobutamine, and rapid volume expansion, has prevented patients from deteriorating neurologically and improved the prognosis. But cases of higher age, poor-grades, and rebleeding remain hard to treat.

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