抄録
A retrospective and prospective analysis of clinical outcome has been conducted in cases of ruptured cerebral aneurysm during the years 1987 to 1994. Our treatment strategy for ruptured cerebral aneurysm is acute surgery except in the cases of moribund condition with brain stem damage, severe vasospasm at the time of admission or severe general complication.
A total of 394 cases were admitted; 51 cases were treated conservatively and 343 cases were operated on. The outcomes of conservatively treated cases were poor; two cases had severe disability, one was in a vegetative state and the others died. Of 343 operations 318 (92.7%) were performed within 24 hours after admission. Operations were delayed in 12 cases because of vasospasm at the time of admission.
The patients who were operated on within 3 days after the attack were divided into two groups according to their hospital admission: 245 patients who were operated on during the years 1987 through 1993 were assigned to one group, and 35 patients operated on in 1994 were assigned to the other. Outcomes were about the same between both treatment period and aneurysm site. Most of the cases with poor outcome were due to the severity of the hemorrhage, vasospasm, and general and operative complications.
Incidence of good outcome was about the same for Grade I to III and incidence of vegetative state and death was about the same for Grade V on admission between the two treatment periods in overall patients. Overall outcome is determined by severity of the grade on admission, and is about the same between the two treatment periods for cases treated with acute surgery. Causes of poor clinical outcome in Grade I to III were vasospasm, rebleeding and general and operative complications. Overall outcome would be improved somewhat by further progress of the treatment for vasospasm and management of the patients in the acute stage.
