抄録
Pathophysiology of preoperative and postoperative angiospasm in cases with ruptured intracranial aneurysm was studied.
Twenty-three cases of ruptured intracranial aneurysm who had neurological signs and symptoms of ischemic lesions caused by cerebral angiospasm (spasm-syndrome) were selected on the basis of symptomatology from 184 consecutive cases with ruptured intracranial aneurysm. These cases were divided into two groups according to the time of development of spasm-syndrome and surgery of aneurysm; those in which spasm-syndrome developed in the preoperative period and those in which spasm-syndrome developed in the postoperative period.
In all cases angiospasm in variable degrees was demonstrated on angiograms which were performed after the development of spasm-syndrome. In the cases with preoperative spasm-syndrome clinical signs and symptoms did not become worse after surgery when operation was delayed until spasm-syndrome was improved. Operative results in these cases were fairly good. Postoperative spasm-syndrome frequently occurred in cases in which operation was performed within 10 days after the episode of subarachnoid hemorrhage (SAH). Neurological signs and symptoms in these cases were much worse than those in the cases with preoperative spasm-syndrome. Characteristic features of postoperative spasm-syndrome at early stages of postoperative periods were extensive diffuse angiospasm together with a round shift of major arteries from the surgically affected side to the opposite on angiograms, and an extensive low density area with compression and deformity of ventricles on computed tomograms, suggesting extensive brain edema on the surgically affected cerebral hemisphere. And then, these findings seen on computed tomograms became cerebral infarction at a later postoperative period. On the other hand, abnormal findings on computed tomograms were not found in 11 of 12 operated cases of ruptured intracranial aneurysm who did not have spasm-syndrome in their clinical courses. Preoperative rCBF measurements showed a marked decrease of cerebral blood flow in the cases with postoperative spasm-syndrome.
From this study, it is likely that postoperative spasm-syndrome is the result of cerebral ischemic lesions caused by angiospasm following SAH and surgical influences.
