80歳以上の破裂脳動脈瘤患者の臨床的特徴と治療成績
脳神経外科領域における手術手技の向上により高齢者であっても手術による悪化例は少なくなってきている10). 近年の報告によれば70歳以上であっても, Hunt & Kosnik grade I, II, IIIの症例では通常サイズの動脈瘤であれば, 急性期手術を行っても慎重な術後管理により, 70歳未満の症例と同様の成績を得ることができる17). しかしながら日本人の平均寿命は平成12年現在, 男77. 64歳, 女84. 62歳と伸び続けており, 80歳以上の超高齢者くも膜下出血患者に遭遇することもまれなことではなくなりつつある. 本報告では, 当施設で経験した80歳以上のくも膜下出血...
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| Published in | 脳卒中の外科 Vol. 30; no. 6; pp. 438 - 442 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本脳卒中の外科学会
30.11.2002
日本脳卒中の外科学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0914-5508 1880-4683 |
| DOI | 10.2335/scs.30.438 |
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| Abstract | 脳神経外科領域における手術手技の向上により高齢者であっても手術による悪化例は少なくなってきている10). 近年の報告によれば70歳以上であっても, Hunt & Kosnik grade I, II, IIIの症例では通常サイズの動脈瘤であれば, 急性期手術を行っても慎重な術後管理により, 70歳未満の症例と同様の成績を得ることができる17). しかしながら日本人の平均寿命は平成12年現在, 男77. 64歳, 女84. 62歳と伸び続けており, 80歳以上の超高齢者くも膜下出血患者に遭遇することもまれなことではなくなりつつある. 本報告では, 当施設で経験した80歳以上のくも膜下出血患者を対象に, 臨床上の特徴と治療成績について検討した. |
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| AbstractList | 脳神経外科領域における手術手技の向上により高齢者であっても手術による悪化例は少なくなってきている10). 近年の報告によれば70歳以上であっても, Hunt & Kosnik grade I, II, IIIの症例では通常サイズの動脈瘤であれば, 急性期手術を行っても慎重な術後管理により, 70歳未満の症例と同様の成績を得ることができる17). しかしながら日本人の平均寿命は平成12年現在, 男77. 64歳, 女84. 62歳と伸び続けており, 80歳以上の超高齢者くも膜下出血患者に遭遇することもまれなことではなくなりつつある. 本報告では, 当施設で経験した80歳以上のくも膜下出血患者を対象に, 臨床上の特徴と治療成績について検討した. We investigated the clinical features of 54 elderly patients aged over 80 years with ruptured intracranial aneurysms admitted to our hospital between May 1968 and December 2001. The changes in patient number, age, male/female ratio, site of cerebral aneurysm and preoperative Hunt & Kosnik grade were studied. The patients were divided into 2 groups (surgically treated group and conservatively treated group). Outcome was evaluated according to the Glasgow Outcome Scale, and the causes of poor results were analyzed. The number of patients calculated for 5-year periods is rising steadily, and reached 25 patients for the last 5 years (1997-2001), accounting for 46% of all. The mean age of the patients was 82.4 ± 2.5 (range 80-92 years), and 44 patients (81%) were under 84 years. The male/female ratio was 1 : 5. The location of 50 ruptured cerebral aneurysms (4 cases were excluded because cerebral angiography was not performed) were the internal carotid artery in 24 cases (48%), the middle cerebral artery in 12 cases (24%), the anterior communicating artery in 11 cases (22%), the anterior cerebral artery in 2 cases (4%), and the basilar artery in 1 case (2%). Their preoperative neurological grades, according to the classification of Hunt & Kosnik, were II in 11 cases (20%), III in 17 cases (31%), IV in 14 cases (26%) and V in 12 cases (22%). Of 54 cases, 26 were treated surgically: neck clipping of cerebral aneurysms was performed in 21 cases, wrapping of cerebral aneurysms in 2 cases, transarterial embolization of cerebral aneurysms in 3 cases and the remaining 28 cases were treated conservatively. The clinical outcome of the surgically treated group was GR in 4 cases (15%), MD in 5 cases (19%), SD in 6 cases (23%), VS in 2 cases (8%) and D in 9 cases (35%). The preoperative Hunt & Kosnik grades of the 4 GR cases were II in 1 case, III in 2 cases, and IV in 1 case. Cerebral infarction caused by cerebral vasospasm was revealed in 10 (38%) of 26 surgically treated cases. The preoperative Hunt & Kosnik grades of these 10 cases were II in 4 cases and III in 6 cases. The clinical outcome was MD in 1 case, SD in 1 case, VS in 1 case and D in 7 cases. Cerebral infarction caused by cerebral vasospasm during the last 5 years (1997-2001) was revealed in 3 (23%) of 13 surgically treated cases, although it was 7 (54%) of 13 cases before 1996. Twenty-two of 28 (79%) conservatively treated cases were serious (Hunt & Kosnik grade IV, V). The clinical outcome was GR in 1 case, SD in 2 cases, VS in 3 cases and D in 22 cases. Causes of death were primary brain damage in 14 cases, re-rupture in 4 cases, cerebral vasospasm in 3 cases and pneumonia in 1 case. It is necessary for determination of surgical indication to evaluate primary brain damage more strictly. And it is indispensable for improvement of operative outcome to take measures for cerebral vasospasm and general complications. |
| Author | 西嶌, 美知春 高橋, 昇 村上, 謙介 野村, 耕章 鈴木, 保宏 |
| Author_FL | TAKAHASHI Noboru SUZUKI Yasuhiro NOMURA Hiroaki MURAKAMI Kensuke NISHIJIMA Michiharu |
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| DocumentTitleAlternate | Characteristics of Elderly Patients Aged Over 80 Years with Ruptured Cerebral Aneurysms |
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| References | 4) Kaku Y, Yonekawa Y, Tsukahara T, et al: Superselective intra-arterial infusion of papaverine for the treatment of cerebral vasospasm after subarachnoid hemorrhage. J Neurosurg 77: 842-847, 1992 2) 平田好文, 松角康彦, 児玉万典, ほか : 高齢者破裂脳動脈瘤の問題点―特に術後合併症, 術後管理面から―. Neurol Med Chir (Tokyo) 27: 1066-1072, 1988 11) Shibuya M, Suzuki Y, Enomoto H, et al: Effects of prophylactic intrathecal administrations of nicardipine on vasospasm in patients with severe aneurysmal subarachnoid haemorrhage. Acta Neurochir (Wien) 131 (1-2): 19-25, 1994 13) 谷川達也, 荒井孝司, 米谷博志, ほか : 高齢者破裂脳動脈瘤患者の臨床的特徴と急性期手術成績. 脳卒中の外科 24: 365-370, 1996 17) 安井敏裕, 矢倉久嗣, 小宮山雅樹, ほか : 高齢者破裂脳動脈瘤の治療方針. 脳神経外科 20: 651-656, 1992 5) Kassell NF, Torner JC, Haley EC Jr, et al: The international cooperative study on the timing of aneurysm surgery. Part 1: Overall management results. J Neurosurg 73: 18-36, 1990 10) 貫井英明, 佐々木秀夫, 金子的実, ほか : 高齢者破裂脳動脈瘤における手術成績とそれに基づく手術適応. 神経外科 25: 275-281, 1985 1) 平井伸治, 小野純一, 山浦 晶, ほか : 高齢者破裂脳動脈瘤急性期手術例の検討. 非高齢者との比較から. 脳卒中の外科 24: 45-50, 1996 12) 鈴木明文, 安井信之, 波出石弘, ほか : 高齢者破裂脳動脈瘤急性期手術例の転帰不良因子. Neurol Med Chir (Tokyo) 28: 1157-1162, 1988 16) 安井敏裕, 坂本博昭, 岸 廣成, ほか : 80歳以上のクモ膜下出血症例の治療経験. 脳卒中の外科 23: 369-373, 1995 3) 井川房夫, 木矢克造, 北岡 保, ほか : 高齢者破裂脳動脈瘤の急性期手術適応の検討―同一施設における手術療法と保存療法の比較―. 脳神経 48: 59-63, 1996 9) 長澤史朗, 大槻宏和, 米川泰弘, ほか : 高齢者破裂脳動脈瘤60例の検討. 脳外 16: 17-21, 1988 8) Mizoi K, Yoshimoto T, Takahashi A, et al: Prospective study on the prevention of cerebral vasospasm by intrathecal fibrinolytic therapy with tissue-type plasminogen activator. J Neurosurg 78: 430-437, 1993 14) 統計局インフォメーション 141 15) 八木伸一, 貫井英明, 西ヶ谷和之, ほか : 高齢者破裂脳動脈瘤直達手術例の転帰の予測. 脳卒中の外科 27: 210-215, 1999 6) Kiyohara Y, Ueda K, Hasuo K, et al: Incidence and prognosis of subarachnoid hemorrhage in a Japanese rural community. Stroke 20: 1150-1155, 1989 7) Kodama N, Sasaki T, Kawakami M, et al: Cisternal irrigation therapy with urokinase and ascorbic acid for prevention of vasospasm after aneurysmal subarachnoid hemorrhage. Outcome in 217 patients. Surg Neurol 53: 110-117, 2000 |
| References_xml | – reference: 9) 長澤史朗, 大槻宏和, 米川泰弘, ほか : 高齢者破裂脳動脈瘤60例の検討. 脳外 16: 17-21, 1988 – reference: 12) 鈴木明文, 安井信之, 波出石弘, ほか : 高齢者破裂脳動脈瘤急性期手術例の転帰不良因子. Neurol Med Chir (Tokyo) 28: 1157-1162, 1988 – reference: 16) 安井敏裕, 坂本博昭, 岸 廣成, ほか : 80歳以上のクモ膜下出血症例の治療経験. 脳卒中の外科 23: 369-373, 1995 – reference: 8) Mizoi K, Yoshimoto T, Takahashi A, et al: Prospective study on the prevention of cerebral vasospasm by intrathecal fibrinolytic therapy with tissue-type plasminogen activator. J Neurosurg 78: 430-437, 1993 – reference: 15) 八木伸一, 貫井英明, 西ヶ谷和之, ほか : 高齢者破裂脳動脈瘤直達手術例の転帰の予測. 脳卒中の外科 27: 210-215, 1999 – reference: 14) 統計局インフォメーション 141 – reference: 5) Kassell NF, Torner JC, Haley EC Jr, et al: The international cooperative study on the timing of aneurysm surgery. Part 1: Overall management results. J Neurosurg 73: 18-36, 1990 – reference: 1) 平井伸治, 小野純一, 山浦 晶, ほか : 高齢者破裂脳動脈瘤急性期手術例の検討. 非高齢者との比較から. 脳卒中の外科 24: 45-50, 1996 – reference: 6) Kiyohara Y, Ueda K, Hasuo K, et al: Incidence and prognosis of subarachnoid hemorrhage in a Japanese rural community. Stroke 20: 1150-1155, 1989 – reference: 10) 貫井英明, 佐々木秀夫, 金子的実, ほか : 高齢者破裂脳動脈瘤における手術成績とそれに基づく手術適応. 神経外科 25: 275-281, 1985 – reference: 13) 谷川達也, 荒井孝司, 米谷博志, ほか : 高齢者破裂脳動脈瘤患者の臨床的特徴と急性期手術成績. 脳卒中の外科 24: 365-370, 1996 – reference: 17) 安井敏裕, 矢倉久嗣, 小宮山雅樹, ほか : 高齢者破裂脳動脈瘤の治療方針. 脳神経外科 20: 651-656, 1992 – reference: 7) Kodama N, Sasaki T, Kawakami M, et al: Cisternal irrigation therapy with urokinase and ascorbic acid for prevention of vasospasm after aneurysmal subarachnoid hemorrhage. Outcome in 217 patients. Surg Neurol 53: 110-117, 2000 – reference: 2) 平田好文, 松角康彦, 児玉万典, ほか : 高齢者破裂脳動脈瘤の問題点―特に術後合併症, 術後管理面から―. Neurol Med Chir (Tokyo) 27: 1066-1072, 1988 – reference: 11) Shibuya M, Suzuki Y, Enomoto H, et al: Effects of prophylactic intrathecal administrations of nicardipine on vasospasm in patients with severe aneurysmal subarachnoid haemorrhage. Acta Neurochir (Wien) 131 (1-2): 19-25, 1994 – reference: 3) 井川房夫, 木矢克造, 北岡 保, ほか : 高齢者破裂脳動脈瘤の急性期手術適応の検討―同一施設における手術療法と保存療法の比較―. 脳神経 48: 59-63, 1996 – reference: 4) Kaku Y, Yonekawa Y, Tsukahara T, et al: Superselective intra-arterial infusion of papaverine for the treatment of cerebral vasospasm after subarachnoid hemorrhage. J Neurosurg 77: 842-847, 1992 |
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| Snippet | 脳神経外科領域における手術手技の向上により高齢者であっても手術による悪化例は少なくなってきている10). 近年の報告によれば70歳以上であっても, Hunt & Kosnik grade I, II, IIIの症例では通常サイズの動脈瘤であれば, 急性期手術を行っても慎重な術後管理により,... We investigated the clinical features of 54 elderly patients aged over 80 years with ruptured intracranial aneurysms admitted to our hospital between May 1968... |
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| SubjectTerms | elderly patients aged over 80 years outcome ruptured cerebral aneurysms treatment |
| Title | 80歳以上の破裂脳動脈瘤患者の臨床的特徴と治療成績 |
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