1995 Volume 23 Issue 6 Pages 455-458
We studied the clinical records of 21 patients from 35 to 80 years old (average 57.8) who were radically operated for subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysms and followed at least 3 months. In all cases, blood clots were removed as widely as possible, and fibrin glue coating therapy was carried out to prevent cerebral vasospasm by protecting the main arteries (C1 portion of the internal carotid artery, M1-M2 portion of the middle cerebral artery, and A1-A2 portion of the anterior cerebral artery) from blood clots. Aneurysm locations were as follows: middle cerebral artery (MCA): 10 cases, anterior communicating artery (Acom A): 6 cases, and internal carotid artery (ICA): 5 cases. All cases were beyond grade 2 in Hunt and Kosnik classification of SAH and belong to group 3 or 4 in Fisher's grading system.
As a result, four cases (19%) presented symptomatic chronic hydrocephalus, and needed ventriculo-peritoneal shunt. Three cases had the location in Acom A (3/6, 50%), and one in ICA (1/5, 20%), respectively. All belonged to grade 3 in Hunt and Kosnik classification and represented diffuse symmetrical high density area in all cisterns in computed tomography. Our result did not represent the high frequency of chronic hydrocephalus compared with the former reports.
In conclusion, fibrin glue coating therapy did not raise the frequency of chronic hydrocephalus in SAH patients. This seems to suggest that intrathecal injection of fibrin glue can be used for various purposes in the field of clinical neurosurgery.
