수술적으로 치료한 파열성 뇌동맥류 1500예의 수술결과 분석
An Analysis of Follow up Results of 1500 Intracranial Ruptured Aneurysms with Surgery
소속 상세정보
최창락/Chang Rak Choi
나형균/이경진/박해관/박성찬/Hyoung Kyun Rha/Kyoung Jin Lee/Hae Kwan Park/Sung Chan Park
KMID : 0359819980270030309
Abstract
결론
이상과 같이 본 교실에서 지난 17년 동안 뇌동맥류 수술 시행한 1500예의 결과를 분석한
결과 다음과 같은 결론 얻었다.
첫째 수술전 good glade한자들에서나 뇌실질 혈종을 동반하여 응급 수술이 필요한 환자
들에서는 조기수술이 필요하리라 생각되나 수술전 poor glade환자들에서는 조기 수술이 오
히려 초기 수술에 의한 직접적인 뇌손상 더욱 악화시킬 수 있기 때문에 지연수술을 시행하
는 것이 좋으리라 생각된다.
둘째, poor grade환자들에 특별한 관심을 갖고 적극적인 초기 치료 및 지속적인 재활 치
료로 이들 grade한자들에서 치료 결과를 높인다.
셋째, 지연성 뇌허혈에 대한 적극적인 관심 및 예방적 치료로 혈관 연축으로 인한 후유증
을 줄여 수술 결과를 향상시킬 수 있을 것이다.
#초록#
The surgical results of 1500 patients with intracranial aneurysms operated in the
neurosurgical department of our university hospital during the 17 year period from 1978
to 1994 were analysed with regard to the preoperative neurological status, preoperative
CT findings and timing of surgical intervention. On the follow up examinations taken
between S months 4o 9 years alter operations, 1115 patients(743%) were classified as
those haying a good recovery, but 905 patients(13.7%) and 88 patients(5.9%) suffered
some morbidity(fair and poor outcome respectively), and 91 patients(6.l%) died Surgical
results for the patients with good neurological status at admission were rally good ;
good outcome for the patients with Hunt and Hess grade 1 was 87 8% and that for
those with grade 2 was 80.9% while it was 29.6% and 4 7% for patients with grade 4
and 5 respectively. There was no difference the rate of good outcome between early(0
to 3 days after bleeding) and late surgery(14 days or more after arachnoid hemorrhage)
groups if poor graded cases were excluded from the early surgery group Outcome was
worse if the surgery was performed during the period between 4th and l0th days after
initial bleeding The major causes of unfavorable outcome(poor and dead) were initial
hemorrhagic insults and delayed ischemic deficits For further improvement of the overall
surgical outcome, several factors must be concerned First early surgical outcome, several
factors must be concerned. First, early surgical intervention is recommended in good
grade patients on admission but it should probable be delayed in patients with poor
grades, Second. Active management of poor grade patients should be scrutinized. Third,
incidence of delayed ischemia may be lowered with positive consideration and preventive
treatment towards vasospasm.
키워드
Intracranial aneurysm; Timing of surgical intervention; Outcome; Hunt and Hess grade.;
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