Early Surgery of Intracranial Aneurysms: Pre- and Intraoperative Care

抄録

Surgical experience focussed on the details of pre- and intraoperative management is presented, based on a consecutive series of 247 patients underwent early surgery for ruptured intracranial aneurysms. Recent trend favors early surgery for ruptured aneurysms. However, it is very likely that swollen brain is easily contused and lacerated, and the pial banks and small vessels, especially the veins, are injured more during an early surgery. Furthermore, subarachnoid blood tends to obscure anatomical details, and aneurysms are prone to rupture during the exposure. To prevent surgical complications, one has to obtain a slack brain and should achieve atraumatic removal of subarachnoid clot, and must try to prevent premature rupture of the aneurysms. It is concluded that surgery for ruptured aneurysms is“surgery of the cisterns”, and surgical outcome may be improved if one appreciate how to handle tight, fragile brain with clot in the subarachnoid cisterns.