Consideration on Early Operation for Ruptured Basilar Bifurcation Aneurysms

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The outcome of 22 cases of ruptured basilar bifurcation aneurysm (BA-BIF) was divided into three groups and the clinical features were reviewed. Thirteen cases were classified into two groups according to the timing of surgery and were compared with nine cases who had been followed without surgery. Significantly fewer cases with"excellent"operative result in the early operation group were found than in the delayed operation group, which seems to be attributable to the serious physiological state (Hunt & Kosnik Grade &) of the patients. On the other hand, patients who were treated conservatively all died due to rebleeding, between one and 42 days after the episode of first hemorrhage. Symptomatic vasospasm occurred frequently (over 50%), but proved not to be fatal except in one case of progressive deterioration. Fatal rebleeding was most often recorded in cases with acute hydrocephalus; and CSF diversion prior to direct clipping seems to be less effective in preventing rebleeding. The above outcome of nonsurgical cases may justify direct clipping, but the timing of clipping in patients with poor clinical grade can not be clearly clarified in our small surgical series. In the early stage, a direct operation was performed as late as the following day, using the pterional approach, and when we encountered the aneurysm neck at a high position, it could not be clipped uneventfully. The zygomatic approach seems to be preferable to the BA-BIF in the early stage, particularly when the aneurysm neck is located at a high position, with several advantages such as sufficient exposure of the operative field with slight elevation of P and minimal brain retraction, allowing a successful clipping.
The Japanese Society on Surgery for Cerebral Strokeの論文

Consideration on Early Operation for Ruptured Basilar Bifurcation Aneurysms

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