Treatment of Subarachnoid Hemorrhages in an Isolated Mountainous Area

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  • OHTA Hirotsugu
    Department of Neurosurgery, Oguni Municipal Hospital
  • KAWANO Seiichirou
    Department of Neurosurgery, School of Medicine, University of Occupational and Environmental Health
  • YAMADA Haruyuki
    Department of Neurosurgery, School of Medicine, University of Occupational and Environmental Health
  • HASHIMOTO Masanori
    Department of Neurosurgery, School of Medicine, University of Occupational and Environmental Health
  • URASAKI Eiichirou
    Department of Neurosurgery, School of Medicine, University of Occupational and Environmental Health
  • YOKOTA Akira
    Department of Neurosurgery, School of Medicine, University of Occupational and Environmental Health

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Other Title
  • 一山間地域におけるくも膜下出血の診療
  • イチ サンカン チイキ ニ オケル クモマクカ シュッケツ ノ シンリョウ

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Abstract

From January 1997 to December 2001, patients with subarachnoid hemorrhage (SAH) among 14,008 residents in an isolated mountainous area ; Oguni and Minamioguni towns in Kumamoto Prefecture, were evaluated. The subjects were patients being treated at Oguni Municipal Hospital. <br>Over a period of 5 years, 19 patients were found to be suffering from SAH in this area, 3 of whom were visitors (residing outside this area). The annual incidence rate of SAH in this area was calculated as 22.9 per 100,000. The sex ratio (men : women) was 4: 12. The average age was 67.9 years ; 65.0 years for men and 68.8 years for women. Eleven patients were older than 65, and constituted 68.8% of the subjects. The risk factors of SAH were recognized, and both hypertension and smoking constituted 31.6%. Alcohol was 21.1 % and hyperlipemia was 15.8%. In 13 clipping operated cases excluding 1 test craniotomy, Hunt & Kosnik's Grades at admission were G.I : 2, G.II : 5, G.III : 3, G.IV : 2 and G.V: 1, and Fisher's Groups were G.I : 0, G.II : 8, G.III : 3 and G.IV : 2. The sites of 16 operated aneurysms were internal carotid-posterior communicating artery (IC-PC) : 2, anterior communicating artery (A Co.A) : 4, middle cerebral artery (MCA) : 10 and vertebral artery-basilan artery (VA-BA) : 0. The aneurysmal sizes were ＜5 mm: 5, 6ー 10 mm: 9 and 11mm ＜: 2 (average 7.6 mm, 2－15mm). The results were evaluated at discharge, excluding 1 SAH of unknown etiology. 9 were good, 2 were dependent and 7 including 5 non-operative cases had died. We were satisfied with these results, because we were treating older patients. <br>Although we attempted the clipping operation using only a three dimensional computed tomographic angiograply (3D-CTA ; X-Vision GX (TOSHIBA) &X-Tension), we had no problem, except for 1 test craniotomy. 3D-CTA was useful during the clipping operation in the small hospital, especially, in regard to cost.

Journal

  • Journal of UOEH

    Journal of UOEH 25 (1), 79-87, 2003

    The University of Occupational and Environmental Health, Japan

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