[Vasospasm, early surgery and nimodipine. A series of 120 consecutive cases of surgically treated ruptured aneurysm]

Abstract

A total of 120 consecutive ruptured aneurysms (An) were managed according to a radio clinical investigation protocol. Preoperative evaluation included clinical grading (Hunt & Hess classification) (3 patients were Gr. I, 62 Gr. II, 27 Gr. III, 13 Gr. IV, 15 Gr. V) angiography (A degree) and C.T.Scan grading. Nimodipine infusion was started before surgery (1 mg/Kg/h). Surgery was performed from Day 0 to Day 3--Control A degrees and C.T.Scan were performed 10 to 12 days after surgery. Post operative C.T.Scan hypodensities were evaluated according to preoperative C.T.scan anc control A degrees. The outcome was evaluated according to the Glasgow Outcome Score (G.O.S.) and the causes of sequelae and decreases were listed according to vasospasm (V.S.), initial hemorrhage and post operative thrombosis (T.H.R.). The outcome was good or excellent in 95.4% of 65 Gr. I.II cases, in 85.9% of 92 Gr. I.II.III cases. Among the causes of disability or death only one case of diffuse severe V.S. was noted; besides that and according to our experience V.S. incidence was lower in this series (25%) than in our previous experience. It is stated that nowadays with Nimodipine treatment and early surgery V.S. is no more a problem.