Microsurgery is very useful for direct operation of intracranial aneurysms due to its good illumination and magnification.
Our experience of 126 cases of direct microsurgical operations of intracranial aneurysms show that the operative mortality was 2.7% (3 deaths in 110 cases) in cases operated on later than the 8th day from the last subarachnoid hemorrhage (SAH) and that the mortality, however, was much higher in the earlier stage 37.5%-6 deaths in 16 cases). In the acute stage, the operative results were not always depending on the conditions (grades) of patients. 4 out of these 6 operative deaths die due to postoperative vasospasm and these cases were operated on just between the 4th and the 8th day from the last SAH. Examined 80 carotid angiograms which were performed on the cases of aneurysms within 3 weeks from last SAH and found that vasospasm of natural course appeared frequently after 6th day from the last SAH and were found earlier than 5th day from SAH. And therefore, patients died from postoperative vasospasm were probably disposed to vasospasm if any stimuli were given to them. On the other hand, cases operated on between 1st and 3rd day, all showed good results.
Microsurgery solved many technical difficulties in handling intracranial aneurysms and therefore, timing of operations aneurysm is now very important. If patients are in good conditions, operation are indicated as soon as possible. However, if patients are admitted between the 4th and 8th day from the last SAH, we think we had better postpone the operation after the 8th day. We try to prevent rebleeding by administration of Trasylol in this period.
Technical details of operations in the acute stage was also discussed.