Effect of Interpeduncular Cisternal Drainage in Acute Phase Operation for Ruptured Aneurysm

Abstract

Out of 161 cases with ruptured aneurysm operated within 3 days of last bleeding, 96 cases in grade 1-3 without intracerebral and/or intraventricular hematoma and troubled operation were studied for incidence of delayed ischemic symptoms and hydrocephalus.
Based on method of treatment, these were divided into two groups. In group 1 of 47 cases from Jan.'78 to Mar.'83, a simple obliteration for aneurysm was performed and 28% of these were kept under continuous ventricular drainage. In group 2 of 49 cases from Apr.'83 to Apr.'85, Liliequist' membranotomy and extensive removal of cisternal clot were done in all the cases and continuous drainage from the interpeduncular cistern was applied to 85% at the time of clipping for aneurysm.
Results were as follows: Delayed ischemic symptoms occurred in 40.4%of the cases in group 1: 20.0 of cases with MC aneurysm, 41.2% with AC, 60.6% with IC. In group 2, these were seen in 24.5%: 36.8% with MC, 18.8% with AC, 14.3% with IC. The difference in the cases with IC aneurysm was statistically significant (p<0.05), the method used in group 2 was thought to be positive in the cases with AC aneurysm and particularly in IC aneurysm. Shunt operation was necessary in 25.5% of the cases of group 2, compared to only 6.1% of group 2 (p<0.05).
During the term to which group 2 cases belonged, 102 cases of 115 with aneurysmal SAH underwent obliteration for aneurysm (88.7%). Seventy-six cases (74.5% of operated cases) were operated within 3 days of the last bleeding by the above mentioned method in order to prevent rebleeding and reduce postoperative complications. The result was that overall mortality decreased from 35.2% to 20.9% (p<0.05).