Summary
During the period between June 1961 and September 1975 320 patients with saccular aneurysms were operated on by intracranial procedures within 14 days of their last subarachnoid hemorrhages. Overall operative mortality rate for the 14 year period was 10.6%, being 18.9% for 143 cases operated on within 7 days of rupture and 4.0% for 177 cases operated on between the 8th and 14th days. The mortality was reduced to the zero level by 1975 in the groups operated on within 48 hours and 8 to 14 days by selection of the patients as well as by improvements in surgical techniques and adjuncts, but did not reach a satisfactory level in the group operated on between th third and seventh days mainly because of fatality due to postoperative vasospasm. The quality of survival after surgery performed within seven days was better than that of surgery performed at eight days or later. Based on these results, the rationale for and technical problems concerning the early stage operations are discussed.
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References
Graf, G. J., Prognosis for patients with nonsurgically treated aneurysms. Analysis of the cooperative study of intracranial aneurysms and subarachnoid hemorrhage. J. Neurosurg.35 (1971), 438–443.
Graf, G. J., Nibbelink, D. W., Cooperative study of intracranial aneurysms and subarachnoid hemorrhage. Report on a randomized treatment study. III. Intracranial surgery. Stroke5 ((1974), 559–601.
Hunt, W. E., Grading of risk in intracranial aneurysms. In: Recent progress in neurological surgery (Sano, K., Ishii, S., eds.). Excerpta Medica ICS320, pp. 169–175. New York: American Elsevier. 1974.
Kågström, E., Palma, L., Influence of antifibrinolytic treatment on the morbidity in patients with subarachnoid hemorrhage. Acta Neurol. Scand.48 (1972), 257–258.
Kwak, R., Okudaira, Y., Suzuki, J.,et al., Problems in hypothermic anesthesia for direct surgical treatment of intracranial aneurysms, with special reference to ventricular fibrillation. Brain Nerve (Tokyo)24 (1972), 403–410.
Locksley, H. B., Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage. Section V, Part II. Natural history of subarachnoid hemorrhage. Intracranial aneurysms and arteriovenous malformations. J. Neurosurg.25 (1966), 321–368.
Miyaoka, M., Nonaka, T., Watanabe, H.,et al., Etiology and treatment of prolonged vasospasm—Experimental and clinical studies. Neurol. Med. Chir. (Tokyo)16 Part II (1976), 103–114.
Mullan, S., Dawley, J., Antifibrinolytic therapy for intracranial aneurysms. J. Neurosurg.28 (1968), 21–23.
Nishijima, Y., Yoshimoto, T., Hori, S., Suzuki, J., Postmortem examination of patients with nonsurgically treated ruptured aneurysms. Neurol. Med. Chir. (Tokyo)16 Part I (1976), 97–104.
Rollason, W. N., Cerebral complications of hypotensive anaesthesia. Brit. Med. J.2 (1963), 402–403.
Slosberg, P. S., Medical treatment of intracranial aneurysm: an analysis of 15 cases. Neurology10 (1960), 1085–1089.
Sonobe, M., Hori, S., Suzuki, J., Effect of spasmogenic substances on cerebral arteries. X. International Congress of Angiology, Tokyo, Aug. 31, 1976.
Suzuki, J., A method of prolongation of temporary stopping of the cerebral blood flow. (Presidential Address) XXXIII. Annual Meeting of the Japan Neurosurgical Society, Sendai, Oct. 22, 1974.
Suzuki, J., Yoshimoto, T., Hori, S., Continuous ventricular drainage to lessen surgical risk in ruptured intracranial aneurysms. Surg. Neurol.2 (1974), 87–90.
Suzuki, J., Hori, S., Prediction of reattacks following rupture of intracranial aneurysms. Neurol. Med. Chir. (Tokyo)18 Part I (1975), 35–39.
Suzuki, J., Iwabuchi, T., Hori, S., Cervical sympathectomy for cerebral vasospasm after aneurysms rupture. Neurol. Med. Chir. (Tokyo)15 Part I (1975), 41–50.
Suzuki, J., Direct surgery of intracranial aneurysms: Experience with over 1,000 cases. Inst. Neurol. Madras Proc.6 (1976), 15–23.
Suzuki, J., Yoshimoto, T., Early operation for the ruptured intracranial aneurysms—Especially the cases operated on within 48 hours after the last subarachnoid hemorrhage. Neurol. Surg. (Tokyo)4 (1976), 135–141.
Yamaguchi, T., Nagaki, J., Omae, T.,et al., Long-term results of non-surgically treated ruptured cerebral aneurysms. II. Annual Meeting of the Japan Stroke Society. Fukuoka, Feb. 2, 1977.
Yoshimoto, T., Suzuki, J., Intracranial definitive aneurysm surgery under normothermia and normotension utilizing temporary occlusion of brain artery and preoperative mannitol administration. Neurol. Surg. (Tokyo)4 (1976), 775–783.
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Hori, S., Suzuki, J. Early intracranial operations for ruptured aneurysms. Acta neurochir 46, 93–104 (1979). https://doi.org/10.1007/BF01407684
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DOI: https://doi.org/10.1007/BF01407684