高齢者重症破裂脳動脈瘤への急性期塞栓術 : Tight packingにこだわらない治療方針から(<特集>高齢者重症くも膜下出血の急性期治療)  [in Japanese] Embolization of Ruptured Aneurysms in Elderly Patients with Severe SAH : Is Tight Packing Really Needed?(Topics : Treatment for the Elderly with Severe SAH)  [in Japanese]

We performed embolization of ruptured intracranial aneurysms using Guglielmi detachable coils (GDC) in 20 patients aged over 70 years at the acute stage (<72hrs) between October 1997 and December 2003. We treated them without the "remodeling technique." The most important point of the embolization was the disappearance of contrast material filling into the aneurysmal bleb. Preoperative World Federation of Neurological Surgeons (WFNS) scale revealed that 11 patients were in poor grade (IV or V). The percentage of the coil volume occupying the aneurysm lumen (EVR : embolized volume ratio) and the Glasgow Outcome Scale (GOS) at discharge were evaluated. The embolized volume ratio (EVR) was under 20% in 8 patients. Although good outcome (good recovery or moderate disability) was obtained in only 3 (27%) of the poor-graded patients, there was no evidence of rebleeding irrespective of EVR. One patient received direct surgery for the remnant of aneurysm after embolization at the chronic stage. We concluded that the embolization using GDC without remodeling technique at the acute stage should be an optional treatment for the elderly patients in poor grade following subarachnoid hemorrhage.