Abstract
Surgery for ruptured basilar aneurysms has been one of the most difficult procedures. Some attempts were made in our clinics to reduce the technical difficulty and improve the surgical result in cases with ruptured basilar aneurysms. In this paper, the effects of these attempts in 55 cases are reported on. Of the 55 cases, aneurysm located at basilar bifurcation comprised 35 cases, junction of basilar artery and superior cerebellar artery 10 cases and junction of posterior cerebral artery and posterior communicating artery 6 cases. The operations were performed within 3 days in 13 cases, 4-7 day in 7 cases and over 8 days in 35 cases. The clinical grades were 1-II in 37 cases, III in 13 cases and IV in 5 cases.
Unilateral pterional approach was carried out and sylvian fissure was opened widely in all cases. Lamina terminalis was opened in 4 cases (7%) and hypoplastic posterior communicating artery was divided in 11 cases out of 35 cases with basilar bifurcation aneurysm (28%). The internal carotid artery was retracted intermittently by aspirator, which was held by the operator's left hand. A temporary clip was used in 20 cases (36%) and the aneurysm was clipped in all cases except one case in which plastic coating was used.
Excellent and good results were obtained in 33 out of 38 cases (89%) classified in grade I-II, in 5 out of 12 cases (42%) in grade III and in one out of 5 cases (20%) in grade IV. The result was not affected by the timing of the operation in grade I-II cases, but in grade III cases the result was better in cases operated on within 3 days (75%) than in cases operated on over 4 days after SAH (25%). The result was not affected by opening of lamina terminalis, division of hypoplastic posterior communicating artery or use of temporary clip.
From these results, we can conclude that early operation will be indicated in grade I-II cases with ruptured basilar aneurysm using above-mentioned procedures, which are useful to facilitate dissection of the aneurysm easy and to perform complete clipping.
