1988 Volume 28 Issue 2 Pages 148-156
The purpose of this paper is to elucidate suitable surgical treatments in patients with aneurysmal subarachnoid hemorrhage (SAH) associated with main artery occlusion. The subjects were nine SAH patients with main artery occlusion (mean age, 53 years). The sites of their occlusions are as follows: internal carotid artery in five; middle cerebral artery (horizontal portion) in three; common carotid artery in one. None of the patients had had cerebral ischemia previously. Surgical results were evaluated at the time of hospital discharge, and were compared with a follow-up study.
Of the four patients who fully recovered, three had been operated on within 48 hours of the onset of SAH, and one underwent bypass surgery following the aneurysmal surgery. Another had symptoms of cerebral vasospasm (VS) 14 days after the SAH in the contralateral hemisphere, but the symptoms disappeared within 1 week and the aneurysm was operated on 21 days later. Among these four patients, the preoperative consciousness level was “alert” in three and “stuporous” in one. Postoperatively, four of the other five patients were partially or fully dependent, and one died. Four were operated on from 9 to 26 days after the SAH, and one underwent surgery 38 hours after the SAH. The preoperative consciousness level of this group was “alert” in three, “drowsy” in one, and “semicomatose” in one. In all five of these patients the main cause of the poor outcome was symptomatic VS, the symptoms of which appeared from 3 to 11 days after the SAH. Four patients had poor collateral circulation, as demonstrated angiographically from 6 to 12 days after the SAH. It is worth noting that a severe neurological deficit developed when a previously asymptomatic arterial occlusion became symptomatic following the occurrence of VS. In conclusion, a bypass procedure following surgery for an aneurysm should be performed within 2 to 3 days after the SAH in the interest of preventing the development of VS-induced cerebral ischemia in the hemisphere in which the arterial occlusion is present.
