Prognostic correlation with the cerebral vasospasm and the direct operation for the intracranial aneurysm

Summary and conclusion

• 1) Direct operations were performed on 218 cases out of 254 cases of intracranial aneurysms experienced by us until the end of March, 1969. The follow-up study ranging from 6 months to 9 years after the operation showed that 19 patients died during hospitalization, 3 patients died within 6 months (the cause of death in 2 of them was unrelated to direct operation), 3 cases died in more than 6 months later, and 192 cases survived beyond 6 months.

• 2) Including non-operative cases, 44 cases of vasospasm were found before the operation. The incidence of vasospasm was 17.3 per cent.

• 3) As for vasospasm cases, there was no death case within 6 months after discharge, and only 2 cases died during hospitalization out of 37 operated cases, the mortality rate being 5.4 per cent. In non-vasospasm cases the mortality rate within 6 months after operation was 10.2 per cent. Comparing these two groups, the result was not worse in the vasospasm group and its mortality rate was better than that of non-vasospasm cases.

• 4) The study brought us to reconsider to some extent the view previously held that in severe vasospasm cases direct operation should not be performed. We are of the opinion that in vasospasm cases, unless they are in coma or on a down hill course, direct operation should be performed thus avoiding any damage to brain.