クモ膜下出血で発症した椎骨脳底動脈解離性動脈瘤における再出血の時期, 頻度と転帰

-自験20例および文献48例の検討-

抄録

We reviewed the clinical characteristics of vertebrobasilar system dissecting aneurysms that presented SAH in 68 patients, including 20 in our institute and 48 from the literature. We especially focused on the incidence and time interval of rerupture in relation to the choice and timing of treatment. The overall rerupture rate including both 43 surgical and 25 non-surgical cases was 54.5% (37/68). Rerupture occurred in 20 of the 43 surgical cases, which included 19 preoperative attacks. Within 24 hours, rerupture occurred in 54.1% (20/37) and in 81.1% (30/37) within the first week. Many of the cases were surgically treated after one week from the onset. The outcome of rerupture was critical, the extent of morbidity and mortality in association with surgical therapy are relatively not serious. A delay in surgical treatment was reflected in the marked high incidence of rerupture. Our results showed that early surgical obliteration of the parent artery is the treatment of choice.