Surgical Indication Based on Operative Results for Cases with Ruptured Vertebro-basilar Aneurysms

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In this paper, we compare the results of early surgery with those of delayed surgery and discuss the indication of early surgery in 146 cases with ruptured vertebro-basilar aneurysms. Depending on age, 146 cases were classified into 2 groups: 116 cases under 64 years old (Y-group) and 30 cases over 65 years old (E-group). Timing of operation (within 3 days after SAH: A, 4-7 days: B, over 8 days: C) and clinical grades by Hunt and Kosnik's classification without attendant were as follows: In Y-group, I-II 17, III 9, IV 5, V 1 in A, I-II 9, III 4 in B, I-II 60, III 9, IV 2 in C. In E-group, I-II 4, 2, IV 3 in A, III 4, IV 1 in B, I-II 10, III 2, IV 4 in C. Timing of the operation did not differ between the Y-group and E-group, but the number of cases classified into HI and IV was significantly larger in the E-group than in the Y-group. Favorable results were obtained as follows : In the Y-group, I-II 15/17 (88%), III 8/9 (89%), IV 2/5 (40%), V 0/1 in A, I-II 9/9 (100%), III 4/4 (100%) in B, I-II 54/60 (90%), III 5/9 (56%), IV 1/2 (50%) in C. In the E-group, I-II 2/4 (50%), III 0/2, IV 2/3 (66%) in A, III 0/4, IV 0/1 in B, I-II 8/10 (8%), III 1/2 (50%), IV 0/4 in C. As a whole, surgical results were better in the Y-group than in the E-group. Unfavorable outcomes due to surgical procedure in Grade I-II cases and primary brain damage in Grade III-IV cases were significantly frequent in the E-group (3/14: 21%, 9/16: 56%) than in the Y-group (3/86: 3%, 6/30: 20%). In the Y-group, outcomes of Grade I-II cases and N cases were not significantly different in the timing of the operation, and the outcome of Grade III cases was better in cases operated on within 7 days after SAH than in cases operated on over 8 days after SAH. In the E-group, the outcome of Grade I-II cases was almost the same irrespective of the timing of the operation except cases over 70 years old with high positioned basilar bifurcation aneurysm. Two out of 3 favorable cases of Grade III and IV were operated on within 3 days after SAH and those cases showed disturbance of consciousness due to acute hydrocephalus. From these results and the results of the literature, which has shown a high incidence of deterioration during waiting for the operation in cases with ruptured vertebro-basilar aneurysms, it can be concluded that surgery must be performed as early as possible after SAH in all Grade I-II cases except cases over 70 years old with high positioned basilar aneurysms, and III and IV cases under 64 years old with ruptured vertebro-basilar aneurysms. Early surgery is also indicated in Grade III and IV cases over 65 years old with disturbance of consciousness due to acute hydrocephalus.
The Japanese Society on Surgery for Cerebral Strokeの論文

Surgical Indication Based on Operative Results for Cases with Ruptured Vertebro-basilar Aneurysms

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