Kinugasa K, Mandai S, Kamata I, Tokunaga K, Sugiu K, Handa A, Nakashima H, Ohmoto T
Department of Neurological Surgery, Okayama University Medical School, Japan.
Neurosurgery. 1995 Apr;36(4):661-7. doi: 10.1227/00006123-199504000-00004.
Six aneurysms in five patients with acute aneurysmal subarachnoid hemorrhages were treated with direct thrombosis using cellulose acetate polymer within 4 hours of rupture. The aneurysms involved the internal carotid and posterior communicating arteries (two patients), the anterior choroidal artery (one patient), the bifurcation of the basilar artery (one patient), and the middle cerebral artery (two patients). Four patients underwent aggressive volume expansion after direct thrombosis with cellulose acetate polymer. The aneurysms remained thrombosed until operations on the necks were performed 2 to 7 weeks after the subarachnoid hemorrhages. Three patients were given intrathecal tissue plasminogen activator. One patient, who remained at neurological Grade V, was not treated surgically and died from cardiac failure. Five aneurysms in the remaining four patients were successfully clipped. These preliminary data suggest that immediate aneurysmal thrombosis, then aggressive preoperative prophylactic volume expansion and/or administration of intrathecal tissue plasminogen activator, can help prevent new bleeding and reduce delayed cerebral ischemia in patients after aneurysmal subarachnoid hemorrhages.
5例急性动脉瘤性蛛网膜下腔出血患者的6个动脉瘤在破裂后4小时内使用醋酸纤维素聚合物进行直接血栓形成治疗。动脉瘤累及颈内动脉和后交通动脉（2例患者）、脉络膜前动脉（1例患者）、基底动脉分叉处（1例患者）和大脑中动脉（2例患者）。4例患者在使用醋酸纤维素聚合物直接血栓形成后进行积极的容量扩张。动脉瘤在蛛网膜下腔出血后2至7周进行颈部手术前一直保持血栓形成状态。3例患者接受了鞘内注射组织型纤溶酶原激活剂。1例仍处于神经功能Ⅴ级的患者未接受手术治疗，死于心力衰竭。其余4例患者的5个动脉瘤成功夹闭。这些初步数据表明，立即进行动脉瘤血栓形成，然后进行积极的术前预防性容量扩张和/或鞘内注射组织型纤溶酶原激活剂，有助于预防动脉瘤性蛛网膜下腔出血患者的再次出血并减少延迟性脑缺血。
