Purpose: To examine the problems concerning surgery for ruptured cerebral aneurysm in the acute phase, patients who were surgically treated on Day 0-Day 2 of the rupture and had unfavorable outcomes were divided into those receiving and not receiving albumin therapy, and factors affecting the prognosis were studied in each group.
Subjects and Methods: Radical treatment of cerebral aneurysm was conducted on Day 0-Day 2 of the occurrence of subarachnoid hemorrhage in 105 patients by 10 surgeons. Those preoperatively showing Hunt & Kosnik grades of I -III (grades not adjusted upward due to circumstantial factors) were divided into those who had received (61 patients) and not received (22 patients) albumin therapy. Twenty of these patients who became severely disabled, showed a vegetative state, or died were then classified according to the factors that were primarily responsible for the outcome: operative insult (OP), operative insult and vasospasm (OP+ VS), vasospasm (VS), and others.
Results: The outcome was unfavorable in 8 (36%) of the 22 patients not treated by albumin therapy, of whom 6 (27%) died. The factors responsible for the outcome were OP in 3 (14%), OP+VS in 3 (14%; treated with isoproterenol), and VS in 2 (9%; 1 treated with isoproterenol and 1 by stellate ganglion blocking). Twelve of the 61 patients treated by albumin therapy showed un-favorable outcomes, and 8 of them died. The factors responsible for the outcome were OP in 8 (13%), OP+VS in 2 (3%), VS in 0, and others in 2 (3%; fulminant hepatitis in 1 and OP+renal failure in 1).
Conclusion: Operative insult and vasospasm accounted for 28% and 23%, respectively, of the causes of the poor outcome in those not treated with albumin. By contrast, operative insult was involved in 18% and vasospasm only in 3% of those treated with albumin, suggesting the effectiveness of albumin therapy.