Experiences of surgical treatment of 400 consecutive ruptured cerebral arterial aneurysms

Summary

This article is a report on our experiences from a consecutive series of 400 cerebral arterial aneurysms submitted to intracerebral surgery. At early operation—within the 11th day of haemorrhage, the operative mortality in cases of planned surgery in groups I and II according to the Botterell classification was 8%, and the operative morbidity 10%. The corresponding figures for late operation—after the 11th day—were 2% and 4%, respectively. In the age group 20–40 years there was no operative mortality and the operative morbidity was 3%.

The best technical result,i.e., complete occlusion of the aneurysm, was obtained in 90% of aneurysms of the carotid and pericallosal arteries, whereas for aneurysms of the middle cerebral and anterior communicating arteries this figure was 71%. Postoperative recurrent haemorrhage occurred in 12 patients, in all of whom the aneurysm had been reinforced with plastic coating.

The frequency of spasm observed at angiography was highest in carotid and middle cerebral arterial aneurysms. At angiographies performed more than 11 days after the haemorrhage middle cerebral aneurysms showed the highest frequency of spasm. The high frequency of spasm with aneurysms of the carotid and middle cerebral arteries led to a greater pre- and postoperative morbidity in patients with these aneurysms than in patients with an aneurysm of the anterior communicating artery.

Follow-up has revealed a satisfactory result in 88% of the patients of groups I and II, while 12% are disabled, this being due in half of them to effects of the haemorrhage itself.