Abstract
We had 127 patients who had unruptured aneurysms associated with ischemic cerebrovascular diseases in our institute from 1969 to 1986.
In 45 cases, direct surgery was performed on the unruptured aneurysms. Conservative treatment was administered in the other 82 cases. There have been five patients with conservative follow up who subsequently had attacks of subarachnoid hemorrhage, and four patients died due to this hemorrhage. Twenty-nine patients (64%) who underwent surgery recovered uneventfully the after operation; on the other hand, the neurological condition of 16 (36%) patients worsened. Six of these patients had only transient symptoms, but 10 had permanent deficit without improvement.
As far as the problem can be said to reside with the patient, the causes of symptomatic worsening after surgery were thought to be fragility of the ischemic brain and arteriosclerotic change around the aneurysm. On the other hand, the techniques of the operation, such as excessive brain retraction, damage to veins or perforating arteries, and stenosis or occlusion of major vessels may have contributed to the worsening of symptoms. Operative processes which would not be injurious in ordinary cases may have had some harmful effect in these cases. Furthermore, senility or general complications may also be considered as causes of deterioration during the post operative course.
So we concluded that surgery for an unruptured aneurysm associated with cerebral ischemia could be performed only in selected cases where the patient has a risk of future aneurysmal rupture but severe complications and major neurological deficit are unlikely to arise. And when surgery is determined to be necessary more cautious and delicate operative techniques are indispensable.
