Abstract
A clinical significance of cervical sympathectomy in the treatment of the cerebral angiospasm showing manifest neurological deficit was discussed. The clinical series comprises 7 cases of ruptured intracranial aneurysms before and after direct aneurysm surgery. Cases were 25 to 63-y-o male and female patints with anterior communicating, uni or bilateral middle cerebral, internal carotid-posterior communicating aneurysm. The cervical sympathectomy consisted of perivascular sympathectomy of the cervical internal carotid and superior cervical sympathetic ganglionectomy of the ipsilateral side to the cerebral angiospasm.
Improvement of infarctic symptoms was observed in 6 cases of this series within 3 days after cervical sympathectomy, among them, within 7 hours in 2 cases and on the next day in another 3 cases. Angiographical improvement was also demonstrated on 2nd day. in 4 cases, 6th day in 1 case and 14th day in another remaining case. In these cases, angio-spastic cerebral infarction symptoms, such as hemiplegia, aphasia, psychiatric disorders or consciousness disturbance not only being persistent for over a week in spite of supportive treatment, but also rapidly developing severe one in a so-called early operation case of ruptured aneurysm seemed to be managed well by cervical sympathectomy. In the last case, cervical sympathectomy was done in advance far before appearance of cerebral infarctic signs. Nevertheless, ipsilateral cerebral angiospasm occured unexpectedly leading the patient to fatal cerebral nfarction. Some unsolved problems as to timing and limitation of the sympathectomy are still left behind. However, it can be said that cervical sympathectomy is one of the most effective treatment at present for the cerebral angiospasm developing infarction symptoms in clinical observation as well as in accordance with one of our co-workers, Dr. Sato's study on innervation of the human cerebral artery combined with physiological experiments.
Thus, this method is suggested in the treatment of various ischemic brain disorders induced by cerebral angiospasm. In such a case, it must be done as a first choice treatment before irreversible brain damage develops, as soon as cerebral infarctic sign appeared.
