重症破裂脳動脈瘤早期手術における世界脳神経外科連合分類 (W.F.N.S. grading) の評価

抄録

In order to clarify the relationship between the operative results and W.F.N.S. grading of patients who underwent early surgical intervention, 58 patients with ruptured aneurysms were investigated. The 58 cases were rated Hunt-Kosnik Grade III and IV. There was no significant difference in outcome or operative procedure between Hunt-Kosnik Grade III and IV. On the other hand, these 58 cases measured on the W.F.N.S. grading broke down into Grades II, III, IV, and V. Using W.F.N.S. grading, the outcome and operative procedure were significant differant between Grades II-III and Grades IV-V. But there was not much difference in outcome or operative procedure between W. F. N. S. Grade II and III, and between Grade IV and V. In addition, 30% of the patients rated Grade IV and V obtained a good outcome more often than mild disability. (Glasgow Outcome Scale) From these results it is concluded that W.F.N.S. grading is superior to Hunt-Kosnik grading from the aspect of operative results, but the existance of patients who achieve a outcome in spite of their poor grade is the point at issue.