抄録
Although there has been a trend toward early operation for ruptured aneurysms of the anterior circulation, there have been few reports about early surgery for ruptured vertebro-basilar aneurysms.
In this paper, the result of early surgery was compared with that of delayed surgery and the timing of the operation was discussed for cases with ruptured vertebro-basilar aneurysms.
Operation was performed within seven days after the bleeding in 16 cases (grade I: three cases, II: five cases, III: five cases, IV: three cases) and over eight days in 48 cases (grade I: 29 cases, Ia: 11 cases, III: five cases, IV: three cases).
The overall results indicated that two patients (13%) remained in poor condition, three patients (19%) expired during early surgery, eight patients (17%) were disabled and three patients (6%) died during delayed surgery. Cases of death during early surgery seemed to be frequent, but these patients were in poor condition before the operation (Hunt and Kosnik's grade III: One case, IV: two cases).
When examining the grade I and II cases, only one case with fusiform aneurysm of the vertebral artery, out of eight cases, was in poor condition and no case expired during early surgery. Two cases out of 29 were disabled and one died during delayed surgery.
A good or excellent outcome was obtained in 88% of early surgery cases and 90% in delayed surgery.
Concerning the grade III and IV cases, one out of eight cases was poor and three cases died in early surgery. Four out of eight cases was disabled and one died in delayed surgery.
A good or excellent outcome was obtained in 50% of early surgery cases and 38% of delayed surgery.
Therefore, the overall results viewed from the point of the clinical grade of the patient before the operation are the same for both groups.
From these results it can be seen that early surgery is indicated in cases with ruptured vertebro-basilar aneurysms as in cases with other aneurysms, except for cases with fusiform aneurysms of the vertebral artery.
