- 一般社団法人 日本脳卒中の外科学会
- 脳卒中の外科 (ISSN:09145508)
- vol.19, no.2, pp.295-300, 1991-07-15 (Released:2012-10-29)
We have originated cisternal irrigation combined with head shaking in order to remove subarachnoid clots rapidly and extensively. Eighteen patients with subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysms of the anterior part of the circle of Willis were studied. The degree of SAH as shown by CT was Group 3 on the Fisher's grading scale. Clipping was performed within 72 hours after the last bleeding. Continuous ventriculo-cisternal irrigation was carried out from 12 hours after the surgery, using solution with or without urokinase. The head was intermittently shaken (amplitude 4 cm, frequency 1.0-2.0 c/s) by a head-shaking device of our own making. The effect of head shaking on clot removal was evaluated by neurological examination, CT, and the volume of sedimentary clots in the draining fluid. Postoperative angiography was usually performed about 10 days after SAH.Although the number of patients was small for statistical analysis, the effect of head shaking on clot removal as shown by CT was remarkable. The subarachnoid clots with CT attenuation values of more than 60 in the basal and sylvian cisterns were usually washed out to the range (10-15) of normal cerebrospinal fluid within 48 hours. No delayed ischemic neurological deficits (DIND) occurred, and no low-density areas due to vasospasm were observed on computed tomography. Angiographic vasospasms were observed in only 2 cases, in which the diameter of the artery was less than 75% of that in the acute phase. But these vasospasms were limited to the area adjacent to the ruptured aneurysm.