[Early operations for ruptured intracranial aneurysms--comparative study with computed tomography (author's transl)]

Area of Science:

• Neurosurgery
• Neuroradiology
• Neurology

Background:

• Subarachnoid hemorrhage (SAH) from ruptured intracranial aneurysms presents significant management challenges.
• Early surgical intervention is a critical factor in patient outcomes.
• CT scan findings, particularly vasospasm, may predict surgical success.

Purpose of the Study:

• To analyze the correlation between the timing of surgical intervention for ruptured intracranial aneurysms and patient outcomes.
• To investigate the relationship between CT scan findings, including vasospasm, and the results of early surgery after SAH.
• To determine optimal surgical timing and management strategies for ruptured intracranial aneurysms.

Main Methods:

• Retrospective analysis of 45 patients who underwent early surgery for ruptured intracranial aneurysms.
• Correlation of surgical outcomes with CT scan findings in 54 patients within two weeks post-SAH.
• Evaluation of mortality and morbidity rates based on surgical timing (within 24 hours vs. 2-7 days post-SAH).

Main Results:

• Patients operated on within 24 hours of SAH had 0% mortality and 16% morbidity.
• Patients operated on during days 2-7 post-SAH had a 38% mortality and 15% morbidity.
• Good surgical outcomes correlated with early intervention (within one week) and CT findings, particularly the absence of symptomatic vasospasm. Symptomatic vasospasm on CT within 3 days predicted poor outcomes.
• Giant intracranial hematomas without significant ventricular or cisternal blood on CT had good surgical results in the acute stage.

Conclusions:

• Early surgical intervention for ruptured intracranial aneurysms, ideally within 24 hours, is recommended.
• Surgical timing and management should consider CT findings, especially vasospasm and the extent of blood in the ventricles and cisterns.
• Procedures like basal cistern clot removal and ventriculo-cisternal drainage can improve outcomes by enhancing cerebrospinal fluid (CSF) circulation.