We evaluate the causative factors of deterioration after surgery for ruptured aneurysm in the cases of Grade I or II, where good outcomes are generally anticipated.
In cases operated on within 3 days after SAH, poor outcome was found in 8 cases (13%) out of 56 cases in Grade I. Poor outcome was also found in 12 cases (11%) out of 110 cases in Grade II. Causes of deterioration in Grade I were vasospasm (VS) in 4, common carotid artery occlusion with unknown causes in 1 and other complications in 3. In Grade II causes, patients deteriorated because of VS in 6, surgical procedures for high-positioned BA aneurysm, VA dissecting aneurysm and IC aneurysm.
In cases operated on between 4 and 14 days after SAH, outcome was poor in 4 (6%) out of 74 Grade I cases. Outcome was also poor in 2 (9%) out of 23 Grade II cases. Causes of deterioration in Grade I were surgical procedures for ICA-AN and VBA-AN, VS in 1, complication in 1. In Grade II causes were surgical procedure for dorsal ICA-AN and, VS in 1.
In cases operated on the day 15 or later after SAH, outcome was poor in 8 (4%) out of 222 Grade I cases. Cause of deterioration in this group were surgical procedures for VBA-AN in 3, ICA-AN and MCA-AN in 1, VS in 1 and other complications in 2.
In summary, VS was the cause of deterioration in many cases of the early operation group, especially in patients over 65 years old.
In the late operation group, surgical procedures were the most common cause of deterioration, especially in patients over 65 years old and in cases with VB aneurysm.
