Fujinaka Toshiyuki, Yoshimine Toshiki, Mashimo Takashi
Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita 565-0871.
Masui. 2012 Sep;61(9):962-70; discussion 970-2.
The annual incidence of aneurysmal subarachnoid hemorrhage (SAH) is approximately 20 per 100,000/ year in Japan, and it is suggested that approximately 40% of SAH patients have poor outcome. Rebleeding after SAH and delayed cerebral vasospasm are the most important causes of poor outcomes. Particularly, rebleeding significantly worsened the outcome, therefore, its prevention is of utmost importance. Preventive measures against rebleeding include open surgery and endovascular treatment without craniotomy. Selection of the measures to prevent rebleeding should be based on neurological assessment, location and shape of cerebral aneurysm, anticipated difficulties in the treatment, presence of complications, etc. At present, surgical clipping remains the method of choice in Japan. However, there has been growing acceptance that the efficacy of endovascular treatment is comparable to that of surgical treatment, suggesting endovascular treatment should be considered in suitable patients with ruptured cerebral aneurysms. In this report, we describe the proceedures for the standard management of SAH, in particular, treatment of ruptured cerebral aneurysm and selection of treatment measures, according to the Japanese guidelines for the management of aneurysmal subarachnoid hemorrhage.
在日本，动脉瘤性蛛网膜下腔出血（SAH）的年发病率约为每10万人每年20例，并且提示约40%的SAH患者预后不良。SAH后的再出血和迟发性脑血管痉挛是导致不良预后的最重要原因。特别是，再出血会显著恶化预后，因此，预防再出血至关重要。预防再出血的措施包括开颅手术和无需开颅的血管内治疗。预防再出血措施的选择应基于神经学评估、脑动脉瘤的位置和形态、预期的治疗难度、并发症的存在等因素。目前，在日本，手术夹闭仍然是首选方法。然而，越来越多的人接受血管内治疗的疗效与手术治疗相当，这表明对于合适的破裂脑动脉瘤患者应考虑血管内治疗。在本报告中，我们根据日本动脉瘤性蛛网膜下腔出血管理指南，描述了SAH的标准管理程序，特别是破裂脑动脉瘤的治疗和治疗措施的选择。
