抄録
In spite of recent advancements in the management of ruptured cerebral aneurysms, it is still difficult to decide whether surgery is indicated and if so when it should be performed for patients admitted with symptomatic vasospasm. While early surgery may protect the patient from rerupture, it may also increase the risk of worsening of vasospasm. We report 5 cases of vasospasm with aneurysmal subarachnoid hemorrhage (SAH). All these cases showed symptomatic and angiographical vasospasm on their admission 3-14 days after initial attack of SAH.
Preoperative clinical gradings of Hunt and Kosnik were Grade 4 in 2 cases, Grade 3 in 2 cases and Grade 2 in 1 case. They were treated by early surgery with clipping followed by percutaneous transluminal angioplasty (PTA) immediately after surgery. Three patients returned to their occupations, while 2 died in spite of therapy.
Early surgery in this series actually prevent further rupturing, but it is not clear whether PTA immediately after clipping may prevent further deterioration by progression of vasospasm. For selected cases especially with reversible ischemic brain damage, this combined treatment may offer more favorable results than late surgery with conservative management. Further investigation is necessary to determine the validity of this therapy.
