- 著者
- 遠山 義浩 杉山 拓 伊東 雅基 村井 宏 馬渕 正二
- 出版者
- 一般社団法人 日本脳卒中の外科学会
- 雑誌
- 脳卒中の外科 (ISSN:09145508)
- 巻号頁・発行日
- vol.35, no.3, pp.174-180, 2007 (Released:2008-08-26)
- 参考文献数
- 21
We investigated the effect of sustained administration of intrathecal nicardipine, calcium antagonist, in 16 cases to prevent post-subarachnoid hemorrhage (SAH) vasospasm. Patients with SAH of Fisher CT Group 3 (15 cases) or Group 4 (1 case) underwent direct clipping surgery and the placement of the cisternal catheter. From 1-4 days after SAH onset, the nicardipine solution (0.09 mg/ml) was continuously injected through the cisternal catheter at the rate of 2 ml/h for 4-16 days. The vasospasm was evaluated from postoperative angiography performed 1 week after SAH onset. The ratios of diameter at internal carotid arteries (ICA) C1 portion, middle cerebral arteries (MCA) M1 portion and anterior cerebral arteries A1 portion were obtained from preoperative and post-operative angiograms. Mild localized vasospasm was observed in 5 cases. The ratios of diameter at C1, M1 and A1 were 1.15±0.19, 1.13±0.23 and 1.17±0.26, respectively. No symptomatic vasospasm was observed in any of the cases. These findings demonstrated that the vaso-dilative effect of nicardipine prevented the post SAH vasospasm of intracranial arteries at C1, M1 and A1. The mild angiographical vasospasm in the 5 cases was probably due to the insufficient delivery of nicardipine solution. Following the operative manipulation of the exposure of ICA and MCA with radical clot removal, administration of nicardipine solution through the catheter in the contralateral carotid cistern and draining from the catheter in ipsilateral sylvian cistern brought the widespread nicardipine delivery to peripheral arteries. Though further improvement of this method is required, sustained intrathecal administration of nicardipine effectively prevents vasospasm following SAH.
- 著者
- 新谷 好正 伊東 雅基 井戸坂 弘之 中林 賢一 卯月 みつる 新谷 知久 早瀬 知 馬渕 正二
- 出版者
- 日本脳神経外科コングレス
- 雑誌
- 脳神経外科ジャーナル (ISSN:0917950X)
- 巻号頁・発行日
- vol.23, no.11, pp.889-896, 2014 (Released:2014-11-25)
- 参考文献数
- 36
- 被引用文献数
- 1
脳動脈瘤の開頭手術において, クリッピングのために瘤の減圧を要する場面に時折遭遇するが, 母血管の一時遮断が困難な例がみられる. そのような例に房室伝導を強力に抑制する作用をもつadenosine triphosphate (ATP) の急速静注による短時間の循環停止 (transient cardiac arrest : TCA) 法が有効である. 経験した全例において短時間の心停止に伴う動脈瘤の著明な減圧が得られ, 安全なクリッピングに大きく寄与した. 合併症はみられなかった. TCA法に習熟した麻酔科医との緊密な連携が不可欠であるが, 本法は母血管の一時遮断に並んで考慮すべききわめて有用な方法である.