Our surgical indication against cerebral aneurysms in acute stages is cases better than comatous stage. Cases showing coma or downhill course are out of indication of immediate operation. At first, these severe cases are treated by the administration of mannitol and recently additional corticosteroid hormone and vitamine E, if necessary, continuous ventricular drainage or aspiration of ventricular hematoma especially in the cases of acute hydrocephalus or ventricular hematoma.
The total number of aneurysm cases admitted to our hospital within 24 hours after hemorrhage was 354 from April, 1978 to December, 1983. The number of grade IV, V cases on admission is 95. Among 91 cases except 4 cases suffered from systemic complications, by these managements 53 cases improved within 48 hours after onset, while 38 cases took a downhill course. Both groups were examined retrospectively in relation to findings of CT scan, sex, age, gradings on admission and sites of ruptured aneurysm. They were devided to 34 cases mainly showing subarachnoid hemorrhage (subarachnoid hemorrhage group) and 57 cases mainly showing intracerebral intraventricular or subdural hematoma (intracranial hematoma group).
In the group of subarachnoid hemorrhage, all of 8 cases with deformity of brain stem died, while 7 of 11 cases without deformity of brain stem and without hydrocephalus recovered within 48 hours after hemorrhage. Moreover, 13 of 14 cases with acute hydrocephalus recovered to grade III or more. The prognosis of cases without deformity of brain stem with or without acute hydrocephalus was significantly better than that with deformity of brain stem.
Cases of grade IV on admission were expected better prognosis than that of grade V, also. However, we could not find relationship between prognosis and age, sex or sites of ruptured aneurysm.
