Abstract
Although vasospasm is still a serious problem for aneurysmal subarachnoid hemorrhage patients, it seems that the incidence has recently decreased. We analyzed the occurrence of vasospasm after acute aneurysm surgery in 270 patients, and compared the incidence and outcome between the first and the latter halves of the 1980's. The occurrence of vasospasm was evaluated by the appearance of ischemic symptoms, with or without CT evidence of infarcts. The overall incidence of vasospasm was 38.3%and 33.6%in the first and the latter periods, respectively. In patients with preoperative Glasgow Coma Scale Scores between 7 and 12, a lower incidence of vasospasm was seen in the latter years, as compared to the first years. On the other hand, the incidence of vasospasm in patients with Glasgow Coma Scale Scores above 13 showed no difference between the two periods. However, the latter period showed significantly lower incidence of infarction in patients of this group. These results proved to be reflected in the decreased mortality and in the increased rate of good outcome in the latter period. In order to confirm whether the results obtained in our clinic is universal, we applied the same analysis to control groups of four cooperative double-blind clinical trials performed during this period in Japan. The study again showed that the rate of infarction as well as the overall incidence of vasospasm have decreased, resulting in the improved surgical outcome. The present study shows that the incidence and severity of vasospasm have decreased, and that the occurrence of infarction has significantly diminished over the decade. In consequence, the rate of poor outcome due to vasospasm after acute surgery is now under 10%
