Clinicostatistical Study of Cerebral Aneurysms : 10 Year Experience Since the Establishment of Our Department (Second Report)

From 1974 to 1983, 302 patients with cerebral aneusysm were admitted to our ward. By Hunt & Kosnik grade, 18 cases were graded 0,82 cases I, 10 cases I a, 86 cases II, 60 cases III, 41 cases IV and 5 cases V. By Fisher's CT classification, 111 cases were graded I, 9 cases II, 99 cases III, 44 cases IV. Regarding treament, clipping was performed in 265 aneuryrms, coating in 26, trapping in 5, cervical ligation in 5, cervical carotid ligation with STA-MCA anastomosis in 5, ventricular drainage in 34 cases, cisternal drainage in 29 and conservative therapy in 28 cases. CSF shunts were made in 68 cases, VP in 60, LP in 4, SP in 1, SP with VP in 1, LP following VP in 2. Of the radically operated cases with initial bleeding and single aneurysm, 20 cases were operated within Day 3, 31 cases between Day 4 and Day 14 and 116 cases after Day 14. Ability of daily life on discharge was excellent in 77 cases, good in 76, fair in 47, poor in 44, dead in 58 (mortality 19.2%). Mortality of delayed operations (9.5%) was fewer than that of other operations (Day 4～14 operation : 16.1%, within Day 3 operation : 45%). However, in the early (within Day 3) admitted patients whose operation was planed to postpone untill after Day 14, mortality increased to 44.4% because of rebleeding and vasospasm. The results of ealy operations (within Day 3) were also poor (mortality 45%). The main factors for poor prognosis were vasospasm, rebleeding and technical problems. From this retrospective study, skillful early surgery and successful therapy for vasospasm such as cisternal drainage etc. will undoubtedly improve results.