Abstract
In this study, several surgical problems in the surgery for acute cerebral aneurysm are discussed relating to the clinical outcome. These include: sinking effect of the decompressive procedures as mannitol administration and ventricular drainage, degree of the brain retraction, and aneurysmal rupture during the operation and temporary clipping.
In particular, the effect of operative procedures on the clinical manifestation of the cerebral arterial vasospasm (VS) are discussed.
Nineteen out of 115 objective cases showed a poor clinical result. The main causes of poor prognosis are VS (12 cases), intracerebral hematoma or brain edema caused by excessive brain retraction (2 cases), re-bleeding attack from residual aneurysm (1 case), normal pressure hydrocephalus (1 case).
Fourty-nine cases (45%) showed symptomatic VS, of these fifteen retained a neurological deficit (N. D.). Twelve out of the 15 resulted in severe N.D. by VS. When the sinking effect of the decompressive procedures is not achieved, the number of case having symptomatic VS with N. D. is significant increase in the occurrence of symptomatic VS. This is true especially with cases existing N. D. Cases with aneurysm rupture and temporary clipping also show a higher incidence of symptomatic VS with N. D.
These operative problems increase the brain edema has subsided pressure of the fragile brain in the acute stage of subarachnoid hemorrhage (SAH). When VS occurred before the brain edema has subsided, decreasing cerebral circulation caused by VS resulted in excessive brain ischemia, and brain damage followed.
Clinical problems of SAH in the acute stage are not limited to VS which is only one of the important pathophysiological conditions as brain edema, increased ICP and so on. So importance of the VS should not be overestimated in the selection of operative procedures and methods, and also medical management.
