Blood clot evacuation in aneurysm surgery in the acute stage (arguments pro and con)

A review of 102 consecutive patients with intracranial aneurysms in a community hospital in Japan

One hundred and two consecutive non selected patients with intracranial aneurysms were reviewed. The incidence of ruptured aneurysm was 17.5 per population of 100,000 per year. The patients were divided into two groups, according to a change of policy that reversed the timing of operations from delayed to early surgery. The overall mortality and occurrence rate of neurological deficits due to vasospasm in patients in Hunt and Kosnik grades I through III were found to be lower during the period with a policy of early surgery. Elderly patients over 70 years old constituted 19% of the cases and those in poor condition (grade IV and V) 31%. These figures in this study are high, which may reflect the fact that these are common problems inherent in the treatment of ruptured aneurysms without patient selection at most community hospitals in the forefront of primary medical care.

Balloon catheter technique for dilatation of constricted cerebral arteries after aneurysmal SAH

The authors describe the technique and explain the reason for the use of an intravascular balloon catheter technique in the treatment of vasospasm in cases of subarachnoid haemorrhage due to rupture of a cerebral aneurysm. In 33 patients with SAH 105 major cerebral arteries were dilated (in the system of internal carotid and basilar arteries). Only in one case vasodilatation could not be accomplished. The effect of dilatation of vasospastic arteries was stable and the functional state of the brain was ameliorated, local and general cerebral dysfunctional signs and symptoms due to vasospasm regressed. The authors discuss indications and contraindications for intravascular balloon dilatation of spastic arteries, the time for the operation, the length of arteries to be dilated, and the possible mechanism of amelioration of cerebral blood flow to the brain stem.