未破裂脳動脈瘤術後の脳血管攣縮

抄録

Objective: Symptomatic vasospasm (VS) following subarachnoid hemorrhage is well known. Delayed symptomatic VS after clipping of unruptured aneurysms (uANs) rarely occurs, but its mechanism remains unclarified.

Based on our experience with two cases of symptomatic VS after clipping of uANs, magnetic resonance angiography (MRA) around postoperative day seven was performed for the investigation of VS after uAN-clipping operations.

Patients and methods: From January 2014 to December 2017, 34 consecutive patients with uANs underwent clipping at our institution. We performed MRA for the detection of VS following clipping of uANs around one week after the operation. Clinical characteristics were compared between the VS and non-VS groups.

Results: MRA-based VS was detected in seven (20.6%) of the 34 patients who underwent clipping of uANs, but these seven patients were asymptomatic. Although the clinical characteristics of these patients were evaluated to identify the risk factors for VS after the clipping of the uANs, there were no statistically significant differences in the analysis of the factors for the occurrence of VS.

Conclusion: Asymptomatic VS after clipping of uANs occurs relatively frequently, and early detection and prompt treatment are important to prevent delayed ischemic deficits.