鋳型状の脳室内血腫を伴う破裂脳動脈瘤患者における予後良好例の検討

抄録

Among 307 cases of subarachnoid hemorrhage in our institution between February 2008 and September 2016, 21 cases of ruptured cerebral aneurysm accompanied by intraventricular hematoma with cast formation (packed IVH) were considered. Excluding cases of deep coma accompanied by bilateral dilated pupils at the time of admission, radical surgery was performed in 13 patients in the extremely early phase, that is, within 12 h of hospital admission. The World Federation of Neurological Surgeons grades upon admission were Grade 5 in 11 cases and Grade 4 in two cases. All nonoperative cases died within a short period. The 6-month outcome of the 13 treated cases was good prognosis in 4 patients at modified Rankin Scale (mRS) 0-2, mRS 3 in 1, mRS 4 in 1, mRS-5 in 4, and death in 3. Treatment for aneurysm was performed with priority on clipping. All patients aged below 60 years receiving treatment regained consciousness; however, all elderly patients had poor prognosis. In cases of “long hour” unconsciousness, where 1 h or more had passed before emergency admission, prognosis was extremely poor, regardless of receiving treatment or not. For patients with ruptured cerebral aneurysm accompanied by packed IVH, who frequently exhibit a high level of disturbance of consciousness, the concept of a therapeutic time window should be kept in mind. In some cases, complete recovery has been achieved as a result of rapid treatment of aneurysm and excision of hematoma.