重症くも膜下出血(WFNS grade IV, V)に対する瘤内塞栓術を第一選択とした治療成績(<特集>SAH重症例)  [in Japanese] Treatment Results for the Severe Subarachnoid Hemorrhage : When Coil Embolization Is Considered as First Option(Treatment Strategy for Severe Subarachnoid Hemorrhage)  [in Japanese]

We evaluate clinical results in patients with severe subarachnoid hemorrhage (World Federation Neurological Surgeons: WFNS Grade IV or V) treated with acute aneurysmal surgery (Coil embolization: CE or Neck clipping: NC) subsequent to aggressive ICP control and brain protection therapy (External decompression (ED), mild hypothermia (HT)). We analyzed the relationship between the surgical procedure (CE or NC) applied and the outcome. From 1998 to 2003, 179 consecutive patients with WFNS Grade IV or V were evaluated in this study. CE was the first choice for aneurysmal surgery, and NC was chosen only for the patients with evacuated intra-cerebral hematoma (ICH), too small (less than 2mm) and unsuitable aneurysmal shape for CE. Among the 57 Grade IV patients, 26 (45.6%) could be treated with CE and another 31 were treated with NC (21 with ICH, 7 too small, 2 unsuitable shape). Twenty-one of these patients underwent ED and 9 were treated with HT. The 15 (57.6%) patients treated with CE and 8 patients (25.8%) treated with NC obtained favorable outcomes at discharge. The 122 patients with WFNS Grade V were classified in 3 groups from the Glasgow Coma Scale (GCS 3, 4 or 5, 6). Two (5%) of GCS 3, 28 (62.2%) of GCS 4 or 5, and 26 (70.2%) of GCS 6 patients underwent aneurysmal surgery (CE 25, NC 31). Thirty-seven of these underwent ED and 22 were treated with HT. Although 6 (16.2%) of the GCS 6 patients (42.9%) of CE and 15.8% of NC) showed favorable outcomes, none of the GCS 3, 4 or 5 patients obtained favorable outcomes at discharge.