抄録
Continuous cisternal drainage (CCD) was performed in 47 of 205 patients with ruptured cerebral aneurysms who underwent CT scan, cerebral angiography and surgical obliteration of the aneurysms within 72 hours after subarachnoid hemorrhage. Patients were included in the vasospasm (VS) group only when they suffered from neurological deterioration which remained until the time of discharge, or resulted in death during the post-operative period.
CCD was more frequently performed in Hunt and Kosnik's grades III and IV patients and in Fisher's CT groups 3 and 4 patients. VS was observed in 26 out of 205 patients (13%). Incidence of VS was significantly higher in Hunt and Kosnik's grade III + IV than in grade I + II. It was also significantly higher in Fisher's CT group 3 + 4 than in group 1 + 2.
The effect of CCD on the prevention of VS was evident in Fisher's groups 3 and 3 + 4. In these groups, the incidence of VS was significantly lower with CCD than without. Although the use of CCD tended to reduce the incidence of VS in all cases, statistical significance was not available. VS occured in 3 (6%) out of 47 cases with CCD, and in 23 (15%) out of 158 cases without CCD.
In this study we conclude that CCD can reduce the incidence of VS in patients with diffuse and severe subarachnoid hemorrhage on preoperative CT scan, but its effect is still not satisfactory for the complete prevention of VS.
