Skip to main content
SpringerLink
Log in

Results of microsurgical management of ruptured intracranial aneurysms

  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Summary

The authors report the results of microsurgical management of 209 cases of ruptured intracranial aneurysms. The outcome of the surgery is discussed from the point of view of operative timing, preoperative grade, age and the effect of vasospasm. The operative results at the time of discharge were as follows: 137 excellent cases, 18 good, 31 fair, 8 poor and 15 deaths. The overall mortality rate was 7% and those patients designated as excellent and good who returned to work fully accounted for 74%. The result was achieved even though 65% of the patients were operated on within 2 weeks after the onset, and 44% of the patients were categorized as grade III, IV and V in Hunt's classification. In the morbidity and mortality, over half of the patients categorized as fair, poor and death were complicated by vasospasm, and the result was attributed mainly to the vascspasm. Therefore, we strongly believe that radical surgery is recommended to prevent rebleeding in the waiting period, there should be a greater understanding of “vasospasm” in order to improve overall morbidity and mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Adams, C. B. T., Loach, A. B., O'Laoire, S. A., Intracranial aneurysms: Analysis of results of microsurgery. Brit. Med. J.2 (1976), 607–609.

    PubMed  Google Scholar 

  2. Aiba, T., The timing of surgical treatment for ruptured intracranial aneurysms. From the viewpoint of intentional delayed operation. Neurol. Med. Chir.21 (1981), 819–828.

    Google Scholar 

  3. Allcock, J. M., Drake, C. G., Ruptured intracranial aneurysms. The role of arterial spasm. J. Neurosurg.22 (1965), 21–29.

    PubMed  Google Scholar 

  4. Bohm, E., Hugosson, R., Experiences of surgical treatment of 400 consecutive ruptured cerebral arterial aneurysms. Acta neurochir. (Wien)40 (1978), 33–43.

    Google Scholar 

  5. Drake, C. G., Intracranial aneurysms. Proc. R. Soc. Med.64 (1971), 477–481.

    PubMed  Google Scholar 

  6. Fisher, C. M., Robertson, G. H., Ojemann, R. G., Cerebral vasospasm with ruptured saccular aneurysms-the clinical manifestations. Neurosurgery1 (1977), 245–248.

    PubMed  Google Scholar 

  7. Fodstad, H., Antifibrinolytic treatment in subarachnoid hemorrhage: Present state. Proc. Symposium “Cerebral aneurysm surgery in the acute stage”, Graz 1981. Acta neurochir. (Wien)63 (1982), 233–244.

    Google Scholar 

  8. Giannotta, S. L., Kindt, G. W., Total morbidity and mortality rates of patients with surgically treated intracranial aneurysms. Neurosurgery4 (1979), 125–128.

    PubMed  Google Scholar 

  9. Guidetti, B., Results of 98 intracranial aneurysm operations performed with the aid of operating microscope. Acta neurochir. (Wien)29 (1973), 65–71.

    Google Scholar 

  10. Holloms, S. A., Decker, R. E., Microsurgical treatment of internal carotid artery aneurysms. J. Neurosurg.47 (1977), 142–147.

    PubMed  Google Scholar 

  11. Hunt, W. E., Kosnik, E. J., Timing and perioperative care in intracranial aneurysm surgery. Clin. Neurosurg.21 (1974), 79–89.

    PubMed  Google Scholar 

  12. Hunt, W. E., Miller, C. A., The results of early operation for aneurysms. Clin. Neurosurg.24 (1977), 208–215.

    PubMed  Google Scholar 

  13. Infuso, L., Bettinelli, A., de Bebedittis, G., Ettore, G., Evaluation of indications for direct surgical management in SAH due to ruptured intracranial aneurysms. Immediate and long-term results in a co-operative study of 678 cases. J. Neurosurg. Sci.19 (1975), 47–53.

    PubMed  Google Scholar 

  14. Krayenbühl, H. A., Yaşargil, M. G., Flamm, E. S., Tew, J. M., Jr., Microsurgical treatment of intracranial saccular aneurysms. J. Neurosurg.37 (1972), 678–686.

    PubMed  Google Scholar 

  15. Jane, J. A., Winn, H. R., Richardson, A. E., The natural history of intracranial aneurysms. Rebleeding rates during the acute and long term period and implication for surgical treatment. Clin. Neurosurg.24 (1977), 176–184.

    PubMed  Google Scholar 

  16. Ljunggren, B., Brandt, L., Kagstrom, E., Sundberg, G., Results of early operations for ruptured aneurysms. J. Neurosurg.54 (1981), 473–479.

    PubMed  Google Scholar 

  17. Locksley, H. B., Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage. Section V, Part III. Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations based on 6368 cases in the cooperative study. J. Neurosurg.25 (1966), 321–368.

    PubMed  Google Scholar 

  18. McKissock, W., Richardson, A., Walsh, L., Anterior communicating aneurysms. A trial of conservative and surgical treatment. Lancet1 (1965), 873–876.

    Google Scholar 

  19. Nibbelink, D. W., Sahs, A. L., Knowler, L. A., Antihypertensive and antifibrinolytic medications in subaradinoid hemorrhage and their relation to cerebral vasospasm. In: Subarachnoid hemorrhage and cerebrovascular spasm (Smith, R. R., Robertson, J. T., eds.), pp. 177–205. Springfield, Ill., U.S.A.: Ch. C Thomas. 1975.

    Google Scholar 

  20. Samson, D. S., Hodosh, R. M., Reid, W. R., Risk of intracranial aneurysm surgery in the good grade patients; early versus late operation. Neurosurgery5 (1979), 422–426.

    PubMed  Google Scholar 

  21. Sano, K., Saito, I., Follow up results of microsurgery of intracranial aneurysms. Brain Nerve29 (1977), 977–985.

    PubMed  Google Scholar 

  22. Sano, K., Saito, I., Timing and indication of surgery for ruptured intracranial aneurysms with regard to cerebral vasospasm. Acta neurochir. (Wien)41 (1978), 49–60.

    Google Scholar 

  23. Skultety, E. M., Nishioka, H., The results of intracranial surgery in the treatment of aneurysms. J. Neurosurg.25 (1966), 683–704.

    Google Scholar 

  24. Sundt, T. M., Jr., Whisnant, J. P., Subarachnoid hemorrhage from intracranial aneurysms. Surgical management and natural history of disease. N. Engl. J. Med.299 (1978), 116–122.

    PubMed  Google Scholar 

  25. Suzuki, J., Onuma, T., Yoshimoto, T., Results of early operations on cerebral aneurysms. Surg. Neurol.11 (1979), 407–412.

    PubMed  Google Scholar 

  26. Symon, L., Perspectives in aneurysm surgery. Proc. Symposium “Cerebral aneurysm. surgery in the acute stage”, Graz 1981. Acta neurochir. (Wien)63 (1982), 5–13.

    Google Scholar 

  27. Weir, B., Aronyk, K., Management mortality and the timing of surgery for supratentorial aneurysms. J. Neurosurg.54 (1981), 145–150.

    Google Scholar 

  28. Winn, H. R., Richardson, A. E., Jane, J. A., The late morbidity and mortality in ruptured single anterior circulation aneurysms treated by non-surgical therapy. Proc. Symposium “Cerebral aneurysm surgery in the acute stage”, Graz 1981. Acta neurochir. (Wien)63 (1982), 71–81.

    Google Scholar 

  29. Yaşargil, M. G., Fox, J. L., The microsurgical approach to intracranial aneurysms. Surg. Neurol.3 (1975), 7–14.

    PubMed  Google Scholar 

  30. Yasui, N., Ito, Z., Ohta, H., Suzuki, A., Surgical problems and pathophysiology in severe cases with ruptured aneurysms in the acute stage. Proc. Symposium “Cerebral aneurysm surgery in the acute stage”, Graz 1981. Acta neurochir. (Wien)63 (1982), 163–174.

    Google Scholar 

  31. Yoshimoto, T., Uchida, K., Kaneko, U., Kayama, T., Suzuki, J., An analysis of follow-up results of 1000 intracranial saccular aneurysms with definitive surgical treatment. J. Neurosurg.50 (1979), 152–157.

    PubMed  Google Scholar 

Download references

Author information

Author notes

  1. S. Fujiwara

    Present address: Department of Neurosurgery. Neurological Institute, Faculty of Medicine, Kyushu University, 812, Fukuoka, Japan

Authors and Affiliations

  1. Department of Neurosurgery, Miyazaki Prefectural Hospital, Miyazaki, Japan

    S. Fujiwara, T. Matsubara & S. Hachisuga

Authors
  1. S. Fujiwara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Matsubara
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Hachisuga
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fujiwara, S., Matsubara, T. & Hachisuga, S. Results of microsurgical management of ruptured intracranial aneurysms. Acta neurochir 68, 227–237 (1983). https://doi.org/10.1007/BF01401181

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01401181

Keywords

Search

Navigation