Abstract
To prevent the possibility of rerupture and the development of vasospasm in the period before aneurysm surgery, we have adopted a policy of performing acute stage operations within 48 hours of the onset of symptoms. The most important indications for acute stage surgery are the patient's level of consciousness and the changes of consciousness over time. Except for Hunt and Kosnik Grade V cases and those whose level of consciousness is progressively downhill, we believe acute stage operation is indicated in all cases.
In the present study, we reported the surgical results of severe cases of ruptured cerebral aneurysms operated on directly during the last 10 years from 1977 to 1986. Among 871 operative cases, the preoperative clinical grades were Grade 0 in 29 cases, I in 218 cases, I a in 28 cases, II in 375 cases, III in 180 cases and IV in 59 cases. The clinical material for this study consists of a total of. 239 Grade III and IV patients. For analysis of the surgical results, we have classified the first 137 cases (those operated on between 1977 and 1981) as Group 1, and the last 102 cases (those operated on from 1982 to 1986) as Group 2. Of the total of 239 patients, 146 (61.1%) were judged to have recovered well, while 72 (30.1%) were morbid. Twenty-one (8.8%) died. When Group 2 is compared to Group 1, it is seen that the mortality rate in Group 2 was the same as in Group 1 (8.8 compared to 8.7%), but the percentage of patients with good recovery rose to 65.7% in Group 2 as compared to 57.7% in Group 1, indicating a notable improvement in the morbidity rate. This improvement of surgical results is obvious in the acute stage operation cases, especially those operated on within 48 hours from the onset. There were 34 cases (25%) in Group 1, and 57 cases (56%) in Group 2 operated on within 48 hours, and the number of patients experiencing a good outcome rose to 68% in Group 2 as compared to 53% in Group 1.
From this study, it is considered that good therapeutic results can be obtained by means of acute stage surgery, even in severe cases, provided that proper care is taken with regard to indications for surgery, choice of surgical approaches, use of measures to prevent or suppress vasospasm, and control of intracranial pressure.
