Yamamoto N
Department of Neurosurgery, Kanazawa Medical University.
No Shinkei Geka. 1993 Jan;21(1):79-82.
Two cases of ruptured cerebral aneurysm with chronic renal failure were successfully treated by selecting an appropriate dialysis during the pre- and postoperative period. Case 1; a 41-year-old male, who had been receiving hemodialysis for 4 years, complained of sudden onset of headache, and his consciousness deteriorated abruptly afterwards. A ruptured basilar-left superior cerebellar artery aneurysm was diagnosed, and an external ventricular drainage device was installed. The patient slowly recovered consciousness and was scheduled for delayed operation. During this period hemodialysis was suspended and continuous ambulatory peritoneal dialysis (CAPD) was performed instead. On the 24th day, the aneurysm was clipped, and CAPD switched to ordinary hemodialysis three days after the operation. However, consciousness deteriorated and CT scan showed diffuse cerebral swelling due to disequilibrium syndrome. The patient recovered consciousness 24 hours after hemodialysis. Frequent short-term dialysis eventually eliminated this syndrome. Case 2; a 60-year-old male, who had been receiving hemodialysis for 6 years, complained of a sudden severe headache, and a ruptured anterior communicating artery aneurysm was diagnosed. Emergency clipping of the aneurysm was performed and, except for mild vasospasm on the seventh day, the patient's recovery was uneventful postoperatively, with non-anticoagulative agent hemodialysis. These two cases demonstrate that chronic renal failure of a ruptured cerebral aneurysm patient can, with good prognosis, be treated by CAPD preoperatively, and non-anticoagulative agent hemodialysis postoperatively, followed by ordinary dialysis carefully avoiding the disequilibrium syndrome.
两例患有慢性肾衰竭的破裂脑动脉瘤患者通过在术前和术后选择合适的透析方法而得到成功治疗。病例1：一名41岁男性，已接受血液透析4年，突发头痛，随后意识急剧恶化。诊断为基底 - 左小脑上动脉动脉瘤破裂，安装了外部脑室引流装置。患者意识逐渐恢复，并计划进行延迟手术。在此期间，暂停血液透析，改为持续非卧床腹膜透析（CAPD）。在第24天，进行了动脉瘤夹闭术，术后三天将CAPD改为普通血液透析。然而，患者意识恶化，CT扫描显示因失衡综合征导致弥漫性脑肿胀。血液透析24小时后患者恢复意识。频繁的短期透析最终消除了该综合征。病例2：一名60岁男性，已接受血液透析6年，突发剧烈头痛，诊断为前交通动脉动脉瘤破裂。对动脉瘤进行了急诊夹闭术，术后除第七天出现轻度血管痉挛外，患者恢复顺利，采用无抗凝剂血液透析。这两个病例表明，破裂脑动脉瘤患者的慢性肾衰竭可以通过术前CAPD和术后无抗凝剂血液透析，随后谨慎避免失衡综合征的普通透析来治疗，且预后良好。
