[Surgery of anterior communicating artery aneurysm--from the experiences of 346 cases (author's transl)]

Abstract

In the past 14 years, 1000 cases of aneurysms were submitted to surgical operations without using microscope. In this report 346 cases of anterior communicating artery aneurysms were studied. The operative result at discharge was as follows; 19 cases (5.5%) were dead, 27 poor, 39 fair, 64 good and 197 excellent. In the follow-up, out of 300 cases 29 were dead (16 were related to the operation), 7 were poor, 13 fair, 26 good and 226 excellent. Out of 19 dead cases during hospitalization, 14 were operated within two weeks after SAH. Ten out of 14 cases operated within two weeks died due to vasospasm and all these 10 cases were operated between five to 11 days after SAH. These results and results of ultra-early surgery on other sites of aneurysm suggested that the surgery should be avoided on the cases from third to 10th day after SAH. After the 3rd day, the operation should be decided by taking vasospasm into consideration. If the SAH attack is a mojor one accompanying loss of consciousness more than one hour, the operation should be postponed until the 14th day. If the SAH attack is a moderate one accompanying loss of consciousness within one hour, it should be postponed until the 9th or 10th day. When the SAH attack doesn't accompany loss of consciousness, the surgery can be done any time. If stiff neck is obvious, it should be performed on the 9th or 10th day. Our approach for anterior communicating artery aneurysms is a interhemispherical approach following the bifrontal craniotomy. Hypothermic anesthesia around 27 degrees C was used in order to prolong the temporary occlusion time until 1971. Since 1972, 500 approximately 800 ml of 20% mannitol was applied intravenously for preventing the infarction following the temporary occlusion under the normothermic general anesthesia. Details of the operative records of 346 cases were analyzed and our operative method, technique and technical points were discussed.