重症くも膜下出血の治療転帰改善にむけての対策(<特集>SAH重症例)  [in Japanese] Prognostic Factors of Severe Subarachnoid Hemorrhage(<topics>Treatment Strategy for Severe Subarachnoid Hemorrhage)  [in Japanese]

We retrospectively analyzed 130 consecutive patients in Hunt and Kosnik Grade IV to V with ruptured intracranial aneurysm to investigate factors relating to unfavorable outcome. The outcome at 2 months after on-set was evaluated according to the Glasgow Outcome Scale. GR and MD were defined as favorable outcome, but SD, VS, and D were considered unfavorable. Aneurysms in the anterior circulation of Willis circle were clipped surgically, and GDC embolization was performed in posterior circulation. Patients having normal brain stem reactions and spontaneous respiration were considered suitable for treatment of aneurysms. Favorable outcomes were seen in 50.8% of Grade IV, and 8.5% of grade V patients. Treating methods-clipping or GDC-were not significant for favorable outcome. Cerebral infarction due to vasospasm, age of over 70 years old and hydrocephalus were significant for unfavorable outcome in Grade IV. GCS scores of 3, 4, and 5 were significant for unfavorable outcome in Grade V. More sensitive monitoring and aggressive treatment of vasospasm, and active rehabilitation with safely managed cisternal drainage are necessary for more favorable outcomes.