Abstract
In the modern treatment of subarachnoid hemorrhage due to a ruptured cerebral aneurysm, the prevention of rebleeding and the management of cerebral ischemia induced by delayed cerebral vasospasm are the greatest problems. Since these morbid processes have not yet been sufficiently elucidated, opinions vary on the timing of surgery for these aneurysms. Although early surgery is generally favored in Japan, we, in this hospital and its affiliated clinics, have made it a principle to use a regimen based on intentionally delayed surgery.
This study was conducted to compare the results of early surgery with those of delayed surgery. The sources of data were the report on 4, 238 cases of cerebral aneurysm (1974-1975) in major neurosurgical clinics across Japan (118 hospitals)—a report made by the Research Group on Cerebrospinal Vascular Abnormalities and designated for intensive studies by the Health and Welfare Ministry—and the records on 906 cases (1972-1979) experienced in Juntendo University Hospital and its branches (10 hospitals). We chose for analysis 1, 288 cases from the former group (hereafter the JNSC group) and 520 from the latter one (the Juntendo group), which were all “acute” cases, hospitalized within 1 week after the bleeding attack. There was no statistically significant difference between the two groups with respect to such variable factors as the patients' backgrounds and quality of surgical treatment.
Non-surgical cases amounted to 29.0% of the JNSC group and 32.1% of the Juntendo group, the opportunity for surgery being missed more frequently in the latter. Surgery was performed within 2 weeks of the bleeding attack in 66.0% of the JNSC group and in 24.8% of the Juntendo group, which clearly shows the difference in therapeutic principle between the two groups. The operative mortality was 26.8% in the JNSC group, as compared with 15.0% in the Juntendo group: significantly higher (p 10.01) in the former. This difference applied equally irrespective of severity of case.
The overall mortality in the combined surgical and non-surgical cases was 41.3% in the JNSC group, as against 39.7% in the Juntendo group, in which respect there was little difference between the groups. Investigation of the surviving patients' daily activities disclosed, however, that the rate of post-operative restoration to society was 66.3% in the JNSC group and 77.9% in the Juntendo group: significantly higher (p 10.01) in the latter.
