In this paper, we compare the results of early surgery with those of delayed surgery and discuss the indication of early surgery in 146 cases with ruptured vertebro-basilar aneurysms.
Depending on age, 146 cases were classified into 2 groups: 116 cases under 64 years old (Y-group) and 30 cases over 65 years old (E-group).
Timing of operation (within 3 days after SAH: A, 4-7 days: B, over 8 days: C) and clinical grades by Hunt and Kosnik's classification without attendant were as follows: In Y-group, I-II 17, III 9, IV 5, V 1 in A, I-II 9, III 4 in B, I-II 60, III 9, IV 2 in C. In E-group, I-II 4, 2, IV 3 in A, III 4, IV 1 in B, I-II 10, III 2, IV 4 in C.
Timing of the operation did not differ between the Y-group and E-group, but the number of cases classified into HI and IV was significantly larger in the E-group than in the Y-group.
Favorable results were obtained as follows : In the Y-group, I-II 15/17 (88%), III 8/9 (89%), IV 2/5 (40%), V 0/1 in A, I-II 9/9 (100%), III 4/4 (100%) in B, I-II 54/60 (90%), III 5/9 (56%), IV 1/2 (50%) in C. In the E-group, I-II 2/4 (50%), III 0/2, IV 2/3 (66%) in A, III 0/4, IV 0/1 in B, I-II 8/10 (8%), III 1/2 (50%), IV 0/4 in C.
As a whole, surgical results were better in the Y-group than in the E-group.
Unfavorable outcomes due to surgical procedure in Grade I-II cases and primary brain damage in Grade III-IV cases were significantly frequent in the E-group (3/14: 21%, 9/16: 56%) than in the Y-group (3/86: 3%, 6/30: 20%).
In the Y-group, outcomes of Grade I-II cases and N cases were not significantly different in the timing of the operation, and the outcome of Grade III cases was better in cases operated on within 7 days after SAH than in cases operated on over 8 days after SAH.
In the E-group, the outcome of Grade I-II cases was almost the same irrespective of the timing of the operation except cases over 70 years old with high positioned basilar bifurcation aneurysm.
Two out of 3 favorable cases of Grade III and IV were operated on within 3 days after SAH and those cases showed disturbance of consciousness due to acute hydrocephalus.
From these results and the results of the literature, which has shown a high incidence of deterioration during waiting for the operation in cases with ruptured vertebro-basilar aneurysms, it can be concluded that surgery must be performed as early as possible after SAH in all Grade I-II cases except cases over 70 years old with high positioned basilar aneurysms, and III and IV cases under 64 years old with ruptured vertebro-basilar aneurysms.
Early surgery is also indicated in Grade III and IV cases over 65 years old with disturbance of consciousness due to acute hydrocephalus.
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