Treatment of Ruptured Cerebral Aneurysms in the Acute Stage

Summary

Computed tomography (CT) findings from 320 cases of ruptured intracranial aneurysm, admitted to our department between 1977 and 1986, were graded from I to V as follows: grade I, no abnormality or isodensity in CT findings; grade II, high-density area only in the cistern in which the intracranial aneurysm exists; grade III, highdensity areas also in cisterns other than that in which the ruptured intracranial aneurysm exists; grade IV, symmetrical, extremely high-density areas in all cisterns; grade V, presence of massive intracranial or intraventricular hematomas. Comparisons were then made of the morbidity and mortality rates between 156 cases operated on within 3 days of subarachnoid hemorrhage (SAH; group A) and 98 cases operated on four or more days afterwards (group B). It was found that early operations performed within 3 days on patients with CT findings of grades I-III were remarkably successful in preventing cerebral vasospasm and rebleeding. However, in patients with grade IV CT findings, early surgery was not so effective in preventing postoperative vasospasm. The overall mortality rate of 12.1% in group A was better than that of 19.5% in group B.

As a result of the introduction of computed tomography (CT), it has become possible to determine the extent and degree of subarachnoid hemorrhage (SAH) in the early stage of ruptured intracranial aneurysms. We discovered that early surgery, performed within 3 days of the rupture, is useful in preventing not only recurrence of hemorrhage, but also cerebral vasospasm, through the removal of the subarachnoid clot at an early stage [1]. The overall mortality and morbidity in the early operations of our series, the correlation between CT findings and surgical results, and the usefulness of CT grading of SAH are discussed.