Abstract
One thousand and eighty intracranial saccular aneurysms were experienced at Tohoku University between June 1961 and Sep. 1975. Direct surgery, clipping and/or ligation of the aneurysm neck, was performed in 1000 cases with a mortality rate during hospitalization of 6.1 percent.
The causes of death in fifty-five of the 61 deaths were retrospectively classified into one due to inappropriateness for surgery, due to complications during surgery and due to complications after surgery. The causes of death in six cases could not be understood sufficiently. They were operated on without complications between the third and seventh day after the initial aneurysmal hemorrhage. Based on the study of these pre and post-operative states and the operative and autopsy findings, the criteria for early surgery are discussed.
If the patient is in the uphill course of consciousness, direct surgery should be done within 24 hours and at latest 48 hours after the attack in order to avoid severe angiospasm caused by massive subarachnoid hemorrhage. During the operation subarachnoid clots should be aspirated as thoroughly as possible, and postoperatively, continuous ventricular drainage should be employed to control intracranial pressure.
Early operations within 48 hours are strongly recommended since the probability of death from severe intracranial vasospasm or irreversible neuropsychiatric complications increases progressively. When the chance for early surgery has been lost, we would like to recommend to delay the direct surgery until the 10th to 14th day when angiospasm may be released. Even in the surgery during this period, appropriate administration of Sodium Nitrite may be effective in preventing severe vasospasm.
Though generally we recommend early direct surgery, cases in the vegetative state or in low consciousness levels should be only treated by shunt operation, and not by intracranial surgery.
