Eighty-two seriously ill patients with ruptured cerebral aneurysms were studied to elucidate the efficacy of surgery and the factors influencing their outcome. All appeared moribund, in semicoma or deep coma, pupils unilaterally or bilaterally dilated and fixed, decerebrate posture, and markedly abnormal respiratory pattern when the operative indication was considered.
Coputerized tomography (CT) scan was taken of all patients on admission and just after subsequent attacks. CT findings were divided into the following three groups: (1)“Hematoma type”having massive intracerebral or subdural hematoma, (2)“Ventricle type”having intraventricular casting hematoma, so called“Hematocephalus”, (3)“Severe SAH type”having dense SAH.
Forty-nine cases were operated on directly. The outcome of these cases was as follows: 7 (14%) fully recovered with no neurological deficits, 11 (22%) were moderately severely disabled with mild neurological deficits, 15 (13%) were severely disabled, 9 (18%) were vegetative and 7 (14%) died.
An attempt to define a therapeutic principle for seriously ill patients with ruptured cerebral aneurysms was made by investigating the efficacy of surgery and the factors influencing outcome, such as CT findings, pre-operative conditions just after administration of 600-900ml of Mannitol, symptomatic vasospasms, complications and so on.
From this study, the following conclusions were“Hematoma type”and Severe SAH type”cases could be cured if the pre-operative symptoms were improved by injection of 20% Mannitol and if the operation could be performed within six hours from the last attack of SAH, while most of the“Ventricle type”patients lapsed into poor condition without direct surgical removal of the intraventricular hematoma. Also, symptomatic vasospasm, other serious complications and surgical troubles such as pre-mature rupture, venous injury and brain contusion secondary to excessive brain retraction contributed to poor outcome.
