抄録
During the past four years, we have treated 29 patients with ruptured posterior circulation aneurysms. To investigate the outcome of this treatment we divided the patients into three groups; an early surgery group, a delayed surgery group, and a no aneurysmal surgery group. Half of these patients were in very poor condition at admission; so only five patients underwent delayed operation. We operated on 10 patients in the acute stage within 72 hours after the last subarachnoid hemorrhage. The outcome for this early surgery group, evaluated on the Glasgow Outcome Scale, was very excellent compared with the other two groups. After the aneurysmal operation we were able to carry out aggressive antispasm treatment, such as hemodilution, induced hypertension and antiplatelet therapy; therefore, the post-operative course in the early surgery group was better. Factors influencing poor prognosis of patients with ruptured cerebral aneurysms are mainly rebleeding and vasospasm. Particularly in the early stage, prevention of rebleeding is thought to be very important. At present it is controversial whether early or delayed operation is more beneficial for ruptured cerebral aneurysms. However, management of delayed operation is very complicated, and the opportunity to operate may be lost with the development of fatal complications. So we strongly believe that, based on this study, early operation is necessary to improve prognosis, even for patients with ruptured posterior circulation aneurysms.
