Principles of Aneurysm Surgery in the Acute Stage of Subarachnoid Hemorrhage

Conference paper
Part of the Advances in Neurosurgery book series (NEURO, volume 20)

Abstract

We experienced 1646 cases of intracranial aneurysms up to the end of 1989; 1519 cases exhibited subarachnoid hemorrhage (SAH). Of these 1519 cases, 171 (11.3%) died of rebleeding while waiting for surgery mostly within 1 week after SAH. The fact has made us consider a possible advantage of early surgery for patients with ruptured aneurysms. However, if we compare the mortality (at 6 months following SAH) of early surgery (within 1 week after SAH) with that of surgery done later than the 1st week, the former was 14.5% (95/655) and the latter was 3.9% (26/674). Therefore, the latter seemed apparently better (Table 1). The latter became 15.2%, however, if the above 11.3% were added to it. Therefore, there was no marked difference in mortality between the two groups, or, one may say, early surgery was a little bit better.

Keywords

Lactate Neurol Hunt Hydrocephalus 

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References

  1. 1.
    Drake CG (1988) Report of World Federation of Neurological Surgeons Committee on a Universal Subarachnoid Hemorrhage Grading Scale. J Neurosurg 68:985–986Google Scholar
  2. 2.
    Hugenholtz H, Elgie RG (1982) Considerations in early surgery on good-risk patients with ruptured intracranial aneurysms. J Neurosurg 56:180–185PubMedCrossRefGoogle Scholar
  3. 3.
    Hunt WE, Hess RM (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14–26PubMedCrossRefGoogle Scholar
  4. 4.
    Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480–484PubMedCrossRefGoogle Scholar
  5. 5.
    Jenett B, Teasdale G (1977) Aspects of coma after severe head injury. Lancet 1:878–881CrossRefGoogle Scholar
  6. 6.
    Kassell NF, Tomer JC (1984) The International Cooperative Study on timing of aneurysm surgery: An update. Stroke 15:566–570PubMedCrossRefGoogle Scholar
  7. 7.
    Kassell NF, Tomer JC et al. (1990) The International Cooperative Study on the timing of aneurysm surgery: Part 1: Overall management results. J Neurosurg 73:18–36PubMedCrossRefGoogle Scholar
  8. 8.
    Kassell NF, Tomer JC et al. (1990) The International Cooperative Study on the timing of aneurysm surgery: Part 2: Surgical results. J Neurosurg 73:37–47PubMedCrossRefGoogle Scholar
  9. 9.
    Kitamura K, Kassell NF, Tomer JC et al. (1987) The Japanese results in the International Cooperative Study on timing of aneurysm surgery. Neurol Surg 15:1155–1166Google Scholar
  10. 10.
    Saito I, Udea Y, Sano K (1977) Significance of vasospasm in the treatment of ruptured intracranial aneurysms. J Neurosurg 47:412–429PubMedCrossRefGoogle Scholar
  11. 11.
    Sano K (1983) Cerebral vasospasm and aneurysm surgery. Clin Neurosurg 30:13–58Google Scholar
  12. 12.
    Sano K, Saito I (1978) Timing and indication of surgery for ruptured intracranial aneurysms with regards to cerebral vasospasm. Acta Neurochir 41:49–60CrossRefGoogle Scholar
  13. 13.
    Sano K, Asano T, Tamura A (1987) Acute aneurysm surgery: pathophysiology and managment. Springer, Wien New YorkGoogle Scholar
  14. 14.
    Suzuki J, Onuma T, Yoshimoto T (1979) Results of early operation on cerebral aneurysms. Surg Neurol 11:407–412PubMedGoogle Scholar
  15. 15.
    Suzuki I, Shimizu H, Takahashi H, Ishijima B (1990) Effect of head shaking method on clot removal in cisternal irrigation. In: Sano K et al. (eds) Cerebral vasospasm. Univ of Tokyo Press, Tokyo, pp 314–316Google Scholar
  16. 16.
    Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet 11:81–84CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1992

Authors and Affiliations

  • K. Sano
    • 1
  1. 1.Department of NeurosurgeryUniversity of Tokyo, Teikyo University Hospital and Fuji Brain InstituteItabashi-Ku, Tokyo 173Japan

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