抄録
Recently, with the development of microsurgery surgical risk of intracranial aneurysm have become less.
That is, by selecting approach to aneurysm, some advantage are obtainable; the range of craniotomy become small elevation of the brain is minimized, temporary clipping of cerebral artery is, in principle, not necessary, leading to unnecessity of requirement for hypothermia. This means that direct surgery of aneurysm is possible in acute cases after hemorrhage.
Recently I have performed direct surgery of intracranial aneurysm on 8 cases with preoperative existed disturbance of consciousness in acute phase.
By acute case, a large frontotemporal craniotomy was performed, the bone flap was removed and the dura was patched with the artificial dura for an exernal decompression. Also, if necessary, an internal a decompression was performed.
In acute patient, a temporary clipping to the parent vessel was not used in order to avoid postoperative vasospasm. Regarding to the case with preoperative vasospasm, the use of hypotension is not desirable, because it may enhance circulatory disturbance.
A neck clipping could be carried not all 8 cases under microscope. Some surgical findings in acute cases were demonstrated by monitoring in a 16mm film.
It is most desirable to treat arterial aneurysm as soon as possible at an early stage and perform decompression for unconscious patient, and then to throughly cope with cerebral edema and vasospasm.
