著者

佐野 公俊 加藤 庸子 藤沢 和久 片田 和広 神野 哲夫

出版者

一般社団法人 日本脳卒中学会

雑誌

脳卒中 (ISSN:09120726)

巻号頁・発行日

vol.7, no.1, pp.37-43, 1985

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急性期破裂脳動脈瘤の治療方針は, 手術時期, 重症例の手術適応, 脳血管李縮の対策など幾多の問題が残され, 意見の統一をみない.<BR>本報告では, 本院にCTが導入され画像の安定した1976年9月から1982年8月までに当院に入院した315例の脳動脈瘤患者の死亡率, symptomatic vasospasmの発生率, 転帰につき, 24時間以内手術例と, それ以外の症例での推計学的検討を行った.<BR>死亡率は24時間以内手術例で82例中28例 (34%) と高いがそのうち26例はgrIV, Vの死亡例である.2週間以後の待期手術例では死亡率は142例中3例 (2%) と低く手術の安定性を示している.そこで24時間以内手術例82例と, それ以外の症例232例につき各重症度別に死亡率の有意差検定を行うと, 重症度がgrIVに近づく程, 24時間以内手術例が有意に優れていた.<BR>symptomatic vasospasmの発生率は, 24時間以内手術例及び2週間の待期中には8%~12%であったが, 48時間~2週間以内の手術例では40%前後と多かった.更に24時間以内手術例とそれ以外の例で推計学的有意差検定を行うと, 重症度がgrIIIに近づく程, 24時間以内手術例が有意に優れていた.<BR>転帰は神経学的重症度がgrIVに近づく程, 有意に24時間以内手術例が, それ以外の症例に比して優れていた.<BR>これらにより, grI, IIで脳底槽血腫の少ない症例に対しては, 再破裂防止の為の早期手術の適応であり, grIIで脳底槽血腫の多い例や, grIII, grIVの例では, クモ膜下出血の病態改善のための早期手術の適応であり, 重症例程, 24時間以内早期手術の絶対適応であるといえる.

著者

佐野 公俊 加藤 庸子 安部 雅人 笠間 睦 神野 哲夫

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.19, no.4, pp.595-597, 1991-12-20 (Released:2012-10-29)

参考文献数

8

被引用文献数

3 2

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In cases of difficult aneurysms the temporary occlusion of blood flow makes the operation easy; however, ischemic damage of the brain must always be considered. Temporary clipping of the parent artery is easy, but ischemic damage may be severe.On the other hand, a tentative clip which is put on the aneurysm either partially or totally, has the following merits:1) Preparation of the aneurysm is easy and safe.2) There is less ischemic damage.But there are the following demerits:1) The part of the aneurysm on which a tentative clip is put should be prepared.2) At the time of tentative clipping the back side of the aneurysm cannot be seen.Temporary clipping and tentative clipping, each has its own merits and demerits.We have to approach aneurysms on the base of sufficient knowledge.

著者

香川 泰生 神野 哲夫 佐野 公俊 片田 和広 MOHAMAD YUSUF SHAH 藤本 和夫 戸田 孝

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

vol.17pt2, no.3, pp.243-251, 1977 (Released:2006-12-28)

参考文献数

17

被引用文献数

1 1

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Diagnosis of thalamic hemorrhage has become more accurate by CT scan, and the precise location and extent of hematoma can be visualized preoperatively, as well as postoperatively, i.e. the follow-up study showing the outcome of hematoma and secondary changes of the brain is more readily available. Operative procedure for such a lesion should be reevaluated. Thalamic hemorrhage constituted 27% of all hypertensive intracerebral hemorrhages in our series (the reported incidence was not so high). According to CT findings (except for 3 cases with giant hematoma), we could classify their main locations into 3 types as follows; —1) anterior type — located in the anterior nuclear group of the thalamus — 2 cases, 2) medial type located in the medial nuclear group of the thalamus — 2 cases, 3) posterolateral type located in the lateral nuclear group of the thalamus — 5 cases. As to the extention of hematoma, we devided all cases into the following 5 types; Type I — localized in the thalamus, Type II — medially extending & perforating into the third ventricle, Type III — laterally extending into the internal capsule and the basal ganglia, Type IV — spreading into all directions, Type V giant hematoma. This classification was found useful in relation to the clinical picture, the operative decision, the choice of operative method and the postoperative prognosis. The onset of the clinical picture was always sudden and included disturbance of consciousness and hemiparesis or hemiplegia. Of 8 cases which allowed a satisfactory clinical examination of sensory and motor function, only few cases showed signs of the thalamic syndrome. In 2 cases of giant hematoma with extensive spread, downward deviation of the eyeballs was noticed. Surgery should be performed; with exceptions to the following conditions — 1) no agreement of family, 2) over 75 years of age, 3) already representing the symptoms of brain stem, 4) severe associated deseases, 5) mild case (mainly level of consciousness). Based on CT findings the most suitable operative procedure should be adopted, — that is, only unilateral C.V.D. (continuous ventricular drainage) on localized type, bilateral or unilateral C.V.D. on medial type, trans-paracallosal approach on anterior type and posterolateral type, trans-temporal approach on lateral extention type, trans-paracallosal or trans-temporal approach combining irrigation-evacuation of the intraventricular clots on giant hematoma type and all extention type. Out of 12 cases six survived, and 3 cases have useful life. Relatively better prognosis was obtained in medial type, and in posterolateral type, but giant hematoma type and all extention type resulted in the worst outcome. In marked lateral extention type of posterolateral type improvement of hemiplegia was not good. Except for the massive intraventricular hemorrhage, the prognosis was dependent on the grade of deterioration of the thalamus, hypothalamus, and the midbrain rather than the ventricular perforation. Even if hematoma was not so large, delayed surgical treatment for C.S.F. obstruction due to ventricular perforation carried the poor prognosis on mortality and morbidity.

著者

前島 伸一郎 土肥 信之 梶原 敏夫 佐野 公俊 神野 哲夫

出版者

一般社団法人 日本脳卒中学会

雑誌

脳卒中 (ISSN:09120726)

巻号頁・発行日

vol.12, no.5, pp.480-483, 1990-10-25 (Released:2009-09-03)

参考文献数

9

被引用文献数

1 1

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混合型超皮質性失語を呈した1例を報告し, 局所脳血流からみた責任病巣と発現機序について考察した.症例は67歳の右利き女性で, 左内頚動脈・前脈絡叢動脈分岐部の動脈瘤クリッピング術後, 右片麻痺と失語症のリハビリ目的で当科を受診した.初診時, 意識は清明で, 右顔面神経麻痺と右片麻痺を認め, 右半身の知覚鈍麻を認めた.言語学的には自発話に乏しく, 呼称や語の想起は著しく障害をうけていた.しかし復唱は良好で, 5~6語の短文でも可能であった.言語の聴覚的理解や文字の視覚的理解はともに単語レベルで障害をうけ, 書字は全く不可能であった.CTでは左前脈絡叢動脈領域に低吸収域を認めたほか, 左中前頭回皮質~皮質下にも低吸収域を認めた。123I-IMP SPECTでは左大脳半球全体に血流低下を認めるが, 言語野周囲の血流は比較的保たれていた.本症例は言語野が2ヵ所の病変によって周辺の大脳皮質から孤立した状態であると推定された.