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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