Abstract
In this paper, case histories are prasented of 38 patients in Hunt & Kosnik Grades III and V who suffered severe ruptured aneurysms with cerebral herniation and had surgical treatment acompanied with decompressed craniotomy, and of 16 patients with severe ruptured aneurysm who were not operated on. In these surgical cases, 30 primary cases suffered early rerupture and massive ICH or subdural hematoma; and eight secondary cases had herniation after the vasospasm or post-operative hemorrhage. The operative procedures were: 1). aneurysmal clipping. 2). decompressed craniotomy. 3). contineous ventricular drainage or cisternal drainage. 4). tracheotomy in about half the cases. A study of the outcome shows that non-surgically treated severe ruptured aneurysmal cases had 94% mortality. On the other hand, surgical cases with decompressed craniotomy had 47% mortality and about 30% returned to a useful (?) life with or without a helper. Technically, decom-pressed craniotomy should be performed with good timing before irreversible change a large enough craniotomy with a dural opening, and an additional decompression technique.
The main cause of severe cases was re-attack a short time after the first attack (usually within six hours). So we should act as soon and as tenderly as possible and perform acute surgical therapy even with or without decompressed craniotomy, especially in severe cases.
