Abstract
The timing of the intracranial surgery of ruptured cerebral aneurysm is the most important for their treatments. The results of the acute stage operation were bad and delayed operation was recommended. While, authors have reported good results on acute stage operation.
Recently international cooperative study about the treatment of ruptured cerebral aneurysms in acute stage is proceeding, and in this paper, authors opinion and operative procedure of ruptured aneurysm in acute stage are reported comparing the results between arely and delayed operation.
Ninety-three cases with single episode of aneurysm rupture admitted within four days after the onset between February in 1981 and February in 1982. Patients condition on admission were relatively good-Fifty-five (59.2%) cases of grade one or two and only four (4.3%) cases of grade five in Hunt and Kosnik's classification. Forty-nine cases were operated upon intracranially soon after their admission and forty-four cases were not operated upon within four days after the onset. In thirty-two of such forty-four cases intracranial operations were carried out after then, but other twelve cases were out of our surgical indication and conservative treatments were performed.
The overall morbidity and mortality rate were followed up after two months from the onset comparing between these two groups-early operation group and others.
As the results of the morbidity rate there was no difference between them, but there was some difference in the mortality rate, there were three dead cases (6.1%) in early operation group and ten dead cases (22.7%) in the later group.
And in the later group there were four died cases due to rebleeding in spite of good condition on their admission.
From these results it was concluded that the cases with ruptured aneurysm must be admitted to neurosurgery soon after initial bleeding and be recommended to perform intracranial operation as early as possible after the admission under the correct surgical indication. But the management of early surgery of ruptured aneurysm is so difficult that authors have developed new device and techniques, for example, the method of evacuation of subarachnoid clots which will cause symptomatic vasospasm, the prolongation method of safety temporary occlusion time of the cerebral arteries preventing premature aneurysm rupture using 20% mannitol solution, the application of the continuous ventricle drainage during and after the surgery controlling the intracranial pressure, the method of prevention of the development of the post-operative vasospasms, converting oxy-hemoglobin which will be one of the strongest vasospasmogenic substance, into metho-hemoglobin using 10 mMol Nallo2 and so on. In this paper such methods were reported precisely.
