Progress in dialysis treatment has been improving the survival rate of chronic dialysis patients, and then which leading to an increase in the neurosurgical complications of them. One case has been reported in the literature of the successful surgical treatment of a ruptured aneurysm in a chronic dialysis patient. There is no widely accepted method of treatment for such patients.
Three cases of ruptured cerebral aneurysm treated successfully in the acute stage are presented in this paper, two of which we reported in the previous paper. The first case was a 50 year-old male (H-K grade I), the second case was a 38 year-old female (H-K grade IV) and the third case was a 46 year-old female (H-K grade III). All of the three patients underwent a preoperative hemodialysis without use of heparin, and were operated on within 24 hours. Decompressive craniotomy and cisternal drainage were performed to reduce the intracranial pressure during postoperative hemodialysis in the acute stage.
Hemodialysis without hepain, which was performed with continuous addition of mannitol and dialysate with a high sodium content to prevent a decrease in intradialytic plasma osmolarity, was carried out daily to achieve precise body fluid regulation.
Plasma osmolarity, intracranial pressure and level of consciousness remained regular during hemodialysis.
We conclude again here that aneurysmal surgery in the acute stage is possible even in patients on maintenance hemodialysis.
