Abstract
Eighteen patients with ruptured aneurysm operated on with microsurgical techniques within 2 weeks after the last subarachnoid hemorrhage(SAH) were analyzed with regards to the surgical treatment and postoperative management.
There were 10 female and 8 male patients. The patients age ranged from 35 to 66 years with a mean age of 49 years.
After the clipping of the aneurysmal neck, we made an effort to incise the membrane of Lilliquist in order to improve the CSF circulation around the ring of Willis. Following these procedures, continuous basal cisternal drainage(BCD) and/or continuous lumbar subarachnoid drainage(LSD) were performed on every cases.
The duration of BCD and/or LSD methods ranged from 4 to 19 days with an average of 10 days. The drained volume of CSF per day ranged from 40.6 to 285.6 ml with a mean volume of 146.4(±66.8)ml.
There were 14 excellent(77.8%) and 2 fair results. The overall mortality was 5.6%(1 patient) and the cause of the death was pseudomonas meningitis.
Probable merits of BCD or LSD method are as follows :
1. It may restore the CSF circulation to normal or physiological state.
2. It clears the CSF of blood around the ring of Willis following SAH.
3. It prevents and cures the postoperative vasospasm which may occur.
4. It may minimize the change in the subarachnoid space after SAH.
This method has the possibility of postoperative meningitis as a complication, but it was not serious with an exception of a patient. The incidence of meningitis increased when the BCD and/or LSD methods was continued for more than a week.
