Experience of Per-acute Operation for Severe Type of Ruptured Intracranial Aneurysm Application of Repeated Irrigation of Basal Cistern

• Published in: Neurologia medico-chirurgica Vol. 20; no. 9; pp. 915 - 921
• Main Authors: KANEKO, MITSUO, HOSAKA, YASUAKI, KOGA, HIROAKI
• Format: Journal Article
• Language: English
• Published: The Japan Neurosurgical Society 1980
• Subjects: cisternal irrigation; per-acute operation; ruptured cerebral aneurysm; subarachnoid hemorrhage
• ISSN: 0470-8105; 1349-8029
• DOI: 10.2176/nmc.20.915

The preoperative condition, surgical treatment, postoperative management and results of 17 cases of a severe type of ruptured intracranial aneurysm operated on within 8 hours after the last subarachnoid hemorrhage were reviewed. The criterion for this severe type of ruptured intracranial aneurysm was designated as grade 4 or 5 according to Hunt and Kosnik. The 17 cases were divided into two groups on the basis of the method of treatment. In the first group of 6 cases, a simple per-acute operation was performed, mostly prior to 1977. Severe vasospasm was frequently encountered on the 3 or 4, postoperative day, and the long-term results were unsatisfactory except in one case which showed improvement soon after evacuation of the associated massive intracerebral hematoma. In the remaining 11 cases, two silicone catheters were left in the basal cistern after clipping of the aneurysm if severe subarachnoid hemorrhage was present. Repeated irrigation was carried out for 7 days at the most using 500 or 1, 000 cc of saline solution or lactate Ringer's solution each time. This resulted in a remarkably decreased incidence of late vasospasm. As a result, 4 of the 11 patients were able to lead a social life and 4 an independent home life. Other group of 16 cases of a severe type of ruptured intracranial aneurysm were admitted within several hours of an attack and followed up for 7 days at the most while being administered conservative treatment using corticosteroid, antifibrinolytic agents, and so on. Ten of the 16 cases died within 24 hours, and 4 thereafter. Only two cases survived for more than 7 days and had successful radical surgery. It is concluded that the best method of treating a severe type of ruptured intracranial aneurysm is to operate as soon as possible and to carry out repeated irrigation of the basal cisterns if severe subarachnoid hemorrhage is noted during the operation.