破裂颅内动脉瘤早期治疗的必要性

目的探讨破裂颅内动脉瘤早期治疗的必要性。方法首次破裂出血的颅内动脉瘤(Hunt-HessⅠ-Ⅳ级)患者62例,其中13例入院后发生再出血。采用单独开颅手术夹闭25例,单独介入栓塞27例,两者结合治疗3例。7例再出血者Hunt-Hess分级转为Ⅴ级,行保守治疗。预后评价采用GOS评分。结果本组再出血率为20.97%。再出血组13例中预后良好5例(38.5%),较差8例(61.5%);未出血组预后良好42例(85.7%),较差7例(14.3%);两组比较,P(0.05。4例术后有明确血管痉挛者1例预后良好,3例较差。早期(3日以内)治疗组21例,预后良好19例(90.48%);中期(3日～2周)治疗组24例,预后良好17例(70.83%);晚期(2周以上)治疗组10例,预后良好6例(60.00%),早期治疗组和中晚期相比,P(0.05。结论对于破裂颅内动脉瘤患者,早期及时进行干预治疗是防止再出血的关键。     

Outcome after endovascular treatment of Hunt and Hess grade IV or V aneurysms: comparison of anterior versus posterior circulation

BACKGROUND AND PURPOSE: The most common cause of poor treatment outcome in patients suffering aneurysmal subarachnoid hemorrhage is cerebral vasospasm, especially in cases of poor Hunt and Hess grades (IV and V). A further prognostic factor in surgically treated patients is aneurysm localization. The aim of the present retrospective study is to compare the endovascular treatment outcome in such poor-grade patients according to aneurysm localization in either the anterior (AC) or posterior (PC) circulation. METHODS: Forty poor-grade patients admitted between 1993 and July 1998 were treated by endovascular approach within 23 days after aneurysm rupture. Eighteen had aneurysms in the AC, 22 in the PC. Mean treatment delay was 4 days after rupture and median, 2 days. One patient showed multiple aneurysms. In 36 cases, aneurysms were occluded by Guglielmi detachable coils; in 4 cases, by parent vessel balloon occlusion. RESULTS: The incidence of delayed ischemic neurological dysfunction or cerebral infarct due to vasospasm did not differ significantly between the AC and PC groups. Two procedure-related complications with clinical effect were observed in each group. At 6 months' follow-up, the result was good in 5 patients and poor in 13 in the AC group and good in 11 patients and poor in 11 in the PC group. CONCLUSION: Given comparable incidence of vasospasm in poor-grade patients, a tendency toward better treatment outcome was found in patients with aneurysms in the posterior circulation (chi(2)=2.04; P=0.15) than in the anterior circulation. Endovascular therapy for poor-grade patients is recommended, as are further studies to determine treatment differences.     

动脉瘤性蛛网膜下腔出血的不同手术时机对预后的影响

目的 探讨不同手术时机对动脉瘤性蛛网膜下腔出血患者预后的影响,总结实施早期手术的技巧.方法 回顾性分析近3年来收治的327例自发性蛛网膜下腔出血（aSAH）患者的临床资料,根据治疗措施和手术时机进行分组,对各组的术中情况和术后结果进行比较.结果 不同手术时机组的术中意外破裂率没有统计学差异,早期手术组和中期手术组治疗结果分级显著差于延期手术组.将非手术组患者分配到不同手术组后,早期手术组和中期手术组的治疗结果分级显著优于延期手术组.结论 aSAH后早期手术不仅能防止再出血降低死亡率,而且可通过清除蛛网膜下腔积血和去除骨瓣而改善预后,值得在临床推广.     

The outcome of early surgical management of ruptured posterior circulation aneurysms

Abstract

Since 7990, early surgery within 3 days following subarachnoid hemorrhage has been performed routinely in our hospital even for ruptured posterior circulation aneurysms. Our experience with early surgical management of 25 patients with posterior circulation aneurysms, including two patients who underwent endovascular surgery, is reported. Fourteen patients had an aneurysm on the basilar, the posterior cerebral or superior cerebellar artery (BAJ, and 77 patients had an aneurysm on the vertebral or posterior inferior cerebellar artery (VA). The mortality and morbidity of the BA group were 7% and 29%, respectively, and those of the VA group were 27% and 9%, respectively. In BA, the incidence ofsymptomatic vasospasm and hydrocephalus was definitely high compared with VA, and the outcome in elderly patients was significantly unfavorable. Early surgery for posterior circulation aneurysms to prevent rebleeding might be considered in selected cases. [Neural Res 1997; 19: 385-388]     

颅内破裂动脉瘤手术时机的临床研究

目的 探讨颅内破裂动脉瘤不同手术时机患者的血清炎性因子水平变化及其临床意义。方法 回顾性分析2017年6月-2019年12月在本院神经外科确诊的颅内动脉瘤性蛛网膜下腔出血患者180例,根据医师建议和患者自愿分为早期治疗组(入院1～3 d进行手术治疗)和延期治疗组(入院4～14 d进行手术治疗),比较2组患者手术前后血清炎性细胞因子水平变化,并对2组患者的疗效和术后并发症发生情况进行比较。结果 手术前2组血清TNF-α,IL-6,IL-1β水平无显著差异(P>0.05); 2组术后第8 d血清TNF-α,IL-6,IL-1β水平均较术前有所降低(P<0.05); 早期治疗组术后第8 d血清TNF-α,IL-6,IL-1β水平显著低于延期治疗组(P<0.05)。早期治疗组的总有效率显著高于延期治疗组(P<0.05); 早期治疗组的恢复良好率显著高于延期治疗组(P<0.05); 早期治疗组的致残率显著低于延期治疗组(P<0.05)。2组重残率、植物生存率及病死率无显著差异(P>0.05)。早期治疗组的颅内感染和脑血管痉挛的发生率明显低于延期治疗组(P<0.05),脑积水和再出血的发生率没有显著差异(P>0.05)。结论 早期治疗的颅内破裂动脉瘤患者的术后血清炎性指标水平变化较显著,疗效及预后均较好,并发症发生率低; 血清炎性指标水平可能与患者的疗效和预后有关,可作为aSAH发生发展的预测指标。     

Intracranial operation within seven days of aneurysmal subarachnoid hemorrhage. Results in 150 patients

We evaluated the results of intracranial operation in 150 consecutive patients surgically treated within seven calendar days of aneurysmal subarachnoid hemorrhage (SAH). Patients in all clinical grades, except those who were moribund, were treated. Those with either anterior or posterior circulation aneurysms were included. On follow-up assessment, favorable outcomes were noted in 107 patients (71%), 17 had major disabilities (11%), and 26 had died (17%). During hospitalization, vasospasm was diagnosed in 63 patients (42%) and rebleeding occurred in 39 (25%). Operations were performed throughout the first week after SAH; results of operation were similar on each day. A lower rate of good recovery was observed among patients operatively treated four to seven days after SAH than among those operated on earlier. The admitting neurologic condition influenced outcome after early operation, but age did not have a major impact. We find that aneurysm surgery can be performed within one week of SAH with acceptable results, although there is room for improvement.     

Combination of aminocaproic acid and nicardipine in treatment of aneurysmal subarachnoid hemorrhage

Antifibrinolytic drugs reduce the risk of rebleeding during the first 2 weeks after aneurysmal subarachnoid hemorrhage. However, they do not lower overall mortality, largely because of an increased incidence of cerebral ischemia. The usefulness of antifibrinolytic drugs might be increased if a method to prevent or control vasospasm in patients were to be developed. We recently completed late Phase I and Phase II studies of the calcium ion blocking drug nicardipine in 67 patients treated within 1 week of subarachnoid hemorrhage. Of these 67 patients, 42 had delayed operations and were treated concomitantly with the antifibrinolytic drug aminocaproic acid (1.5 g/hr) for an average of 6 days before surgery. The outcome of these 42 patients is the subject of this report. Fifteen of 42 patients were treated with the lower dosage levels of nicardipine (0.4-4.5 mg/m2/hr), and 27 patients were treated at the highest dosage level (6.0 mg/m2/hr). Using the World Federation of Neurological Surgeons scale for subarachnoid hemorrhage, at admission 18 patients were Grade I, 15 were Grade II, 6 were Grade III, and 3 were Grade IV. Five patients (12%) developed clinical signs of deterioration suggestive of cerebral ischemia with concomitant evidence of vasospasm on arteriography. These patients were all treated with hypervolemic hypertensive therapy. Only one patient (2%) developed an infarction from vasospasm. Two patients developed symptomatic hydrocephalus requiring ventriculoperitoneal shunting, and a third patient required a temporary ventriculostomy. The 3-month postoperative outcomes were excellent. Three patients (7%) rebled. Three patients died, two from rebleeding of the aneurysm and one who never regained consciousness from the initial hemorrhage.(ABSTRACT TRUNCATED AT 250 WORDS)     

出血性颅内动脉瘤患者延期手术治疗存在的相关问题探讨

目的了解出血性颅内动脉瘤患者延期手术治疗存在的相关的危险因素。方法对2002年至2010年收治的89例出血性颅内动脉瘤患者的临床资料,特别是在住院等待手术期间的临床资料进行回顾性分析。结果 89例出血性动脉瘤患者在延期手术期间并发动脉瘤再次破裂出血9例(10.11%),脑血管痉挛25例(28.09%),脑积水15例(16.85%)。术后按GOS评分,恢复良好66例,中残12例,重残4例,死亡7例;病残率17.98%,死亡率7.87%。结论出血性颅内动脉瘤患者在延期手术治疗期间动脉瘤再破裂出血、脑血管痉挛及脑积水发生率高,应采取多方面措施积极干预,才能提高其治愈率、降低死亡率和致残率。     

Conservative treatment of ruptured vertebrobasilar dissecting aneurysm

Ruptured vertebrobasilar dissecting aneurysm is usually treated surgically because rebleeding negatively affects outcome. However, the risk of rebleeding decreases markedly once several hours have passed from the initial bleeding. Moreover, surgery-related complications are not rare. We describe seven patients with ruptured vertebrobasilar dissecting aneurysm. To prevent rebleeding during the acute stage, we treated all seven patients conservatively with fentanyl instead of emergency surgery. During the follow-up period (mean 20 months), no patient suffered rebleeding. Conservative treatment with fentanyl administration may be a good option for management of ruptured vertebrobasilar dissecting aneurysm during the acute stage.     

Seizures and Anticonvulsants after Aneurysmal Subarachnoid Hemorrhage

Seizures and seizure-like activity may occur in patients experiencing aneurysmal subarachnoid hemorrhage. Treatment of these events with prophylactic antiepileptic drugs remains controversial. An electronic literature search was conducted for English language articles describing the incidence and treatment of seizures after aneurysmal subarachnoid hemorrhage from 1980 to October 2010. A total of 56 articles were included in this review. Seizures often occur at the time of initial presentation or aneurysmal rebleeding before aneurysm treatment. Seizures occur in about 2% of patients after invasive aneurysm treatment, with a higher incidence after surgical clipping compared with endovascular repair. Non-convulsive seizures should be considered in patients with poor neurological status or deterioration. Seizure prophylaxis with antiepileptic drugs is controversial, with limited data available for developing recommendations. While antiepileptic drug use has been linked to worse prognosis, studies have evaluated treatment with almost exclusively phenytoin. When prophylaxis is used, 3-day treatment seems to provide similar seizure prevention with better outcome compared with longer-term treatment.     

Does treatment modality of intracranial ruptured aneurysms influence the incidence of cerebral vasospasm and clinical outcome?

BACKGROUND: Cerebral vasospasm is the most common cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage (SAH). This study is designed to determine whether the incidence of symptomatic vasospasm and the overall clinical outcome differ between patients treated with surgical clipping compared with endovascular obliteration of aneurysms. METHODS: In this prospective study, 98 patients with aneurysmal SAH were treated. Seventy-two patients underwent surgery and clipping and 26 had coil embolization. The incidence of symptomatic vasospasm, permanent neurologic deficit due to vasospasm and clinical outcome were analyzed. Patients with better clinical and radiological grades (World Federation of Neurological Surgeons grades I-III and Fisher grades I-III) were analyzed separately. RESULTS: Symptomatic vasospasm occurred in 22% of the patients; 25% in the surgical group and 15% in the endovascular group. Nine percent of the patients in the surgical group and 7% in the endovascular group suffered ischemic infarction with permanent neurological deficit. These differences did not reach statistical significance (p = 0.42). For patients with better clinical and radiological grades, no significant difference was found for the rate of symptomatic vasospasm; 23% in the surgical and 12% in the endovascular group (p = 0.49). The overall clinical outcome was comparable in both groups, with no difference in the likelihood of a Glasgow Outcome Scale score of 3 or less (15% in the surgical and 16% in the endovascular group; p = 0.87). The same results for outcome were obtained for the subgroup of patients with better clinical grades on admission. CONCLUSION: Symptomatic vasospasm and ischemic infarction rate seem comparable in both groups, even for patients with better clinical and radiological admission grades. There is no significant difference in the overall clinical outcome at the long-term follow-up between both groups.     

Hunt-Hess Ⅰ～Ⅲ级动脉瘤性蛛网膜下腔出血早期手术术前腰大池外引流的临床观察

目的 探讨Hunt-Hess Ⅰ～Ⅲ级动脉瘤性蛛网膜下腔出血(SAH)早期手术术前腰大池外引流的临床疗效.方法 将早期手术的Hunt-Hess Ⅰ～Ⅲ级动脉瘤性SAH患者分为术前腰大池外引流组(47例)和术后腰大池外引流组(54例),分析两组病例的疗效差异.结果 术前腰大池外引流组无置管导致的动脉瘤再破裂出血病例,其术中动脉瘤破裂、症状性脑血管痉挛、慢性脑积水的发生率分别为8.5%、12.8%、12.8%,均低于术后腰大池外引流组的11.1%、20.4%、14.8%.结论 术前行腰大池外引流无增加Hunt-Hess Ⅰ～Ⅲ级动脉瘤性SAH早期手术患者动脉瘤再破裂出血的风险,并且可降低症状性脑血管痉挛和慢性脑积水的发生率.

Abstract：

Objective To explore the therapeutic effect of preoperative external hunbar drainage in Hunt and Hess grade Ⅰ～Ⅲ patients with subarachnoid hemorrhage ( SAH ) undergoing early surgery for intracranial aneurysms. Method The 101 cases of grade Ⅰ～Ⅲ patients according to the classification of Hunt and Hess with early surgical treatment were devided into preoperative external lumbar drainage group(47 cases) and postoperative external lumbar drainage group(54 cases).Outcome of patients with different external drainage of cerebrospinal fluid was analyzed. Results There was no case of aneurysm rebleeding could be associated with preoperative spinal drain placement. Tne incidences of intraoperative aneurysm rapture in preoperative external lumbar drainage group was 8. 5%,which was lower than 11. 1% in postoperative external lumbar drainage group. The incidences of symptomatic cerebral vasospasm and chronic hydrocephalus in preoperative external lumbar drainage group were 12. 8% and 12.8% ,which were lower than 20. 4% and 14. 8% in postoperative external lumbar drainage group. There all were not significant differences between the two groups. Conclusions Preoperative external lumbar drainage wont increase a risk of rebleeding for grade Ⅰ～Ⅲ patients with aneurysmal SAH undergoing early surg ery. Furthermore, it can decrease the incidences of symptomatic cerebral vasospasm and chronic hydrocephalus,which is a safe and useful method of removing bloody cerebrospinal fluid.     

Outcome in elderly patients with ruptured intracranial aneurysm

Sixty-nine elderly patients over 65 years old with ruptured aneurysms had a significantly worse outcome than 192 younger patients with respect to overall management results and operative results (p less than 0.01). The results of an early operation were better in the elderly patients with grade I-III than in those receiving a delayed operation. Concomitant diseases significantly influenced the results in elderly patients (p less than 0.05). It is possible that an early operation results in the better outcome in elderly patients by decreasing the incidence of delayed ischemic complications and preventing rebleeding.     

Predictors and impact of aneurysm rebleeding after subarachnoid hemorrhage

BACKGROUND: Aneurysm rebleeding has historically been an important cause of mortality after subarachnoid hemorrhage (SAH). OBJECTIVE: To describe the frequency and impact of rebleeding in the modern era of aneurysm care, which emphasizes early surgical or endovascular treatment. DESIGN: Inception cohort. SETTING: Tertiary care medical center. PATIENTS: A total of 574 patients enrolled in the Columbia University SAH Outcomes Project between August 1996 and June 2002. Early aneurysm repair was performed whenever feasible. MAIN OUTCOME MEASURES: Rebleeding was defined by prespecified clinical and radiographic criteria, excluding prehospital, intraprocedural, and postrepair events. Functional outcome was assessed at 3 months with the modified Rankin Scale. Multiple logistic regression was used to identify predictors of rebleeding, poor functional outcome, and mortality. RESULTS: Rebleeding occurred in 40 (6.9%) of the 574 patients; most cases (73%) occurred within 3 days of ictus. Hunt-Hess grade on admission (odds ratio [OR], 1.92 per grade; 95% confidence interval [CI], 1.33-2.75; P<.001) and maximal aneurysm diameter (OR, 1.07/mm; 95% CI, 1.01-1.13; P = .005) were independent predictors of rebleeding. After controlling for Hunt-Hess grade and aneurysm size, rebleeding was associated with a markedly reduced chance of survival with functional independence (modified Rankin Scale score, 相似文献   

Antifibrinolytic Therapy To Prevent Early Rebleeding After Subarachnoid Hemorrhage

In the current era of early surgery, there has been little interest in the use of antifibrinolytic therapy to prevent rebleeding after aneurysmal subarachnoid hemorrhage (aSAH). Older studies demonstrated that antifibrinolytics can reduce rebleeding, but long-term therapy results in increased cerebral ischemia from vasospasm, leading to no appreciable effect on mortality. While early surgery would seem to obviate the need for long-term antifibrinolytic use, a subgroup of patients may benefit from early therapy. The rate of pre-operative rebleeding may be as high as 9–17%, causing significant morbidity and mortality. Short-term use of antifibrinolytic agents (less than 3 days) in the presence of calcium channel blocking therapy has shown promising results. A randomized clinical trial of early antifibrinolytic therapy conducted in 2002 showed a significant decrease in rebleeding and a non-significant decrease in overall mortality. In this review, we examine the clinical pharmacology, dosing, monitoring, complications, and side effects of antifibrinolytic treatment. We conclude that early short-term antifibrinolytic therapy might be a reasonable strategy to prevent acute rebleeding and improve long-term outcome in aSAH patients. Additional randomized clinical trials are necessary to determine whether this management strategy is effective.     

Cerebromeningeal hemorrhage. Analysis of autopsies performed over a 10-year period

A study was conducted on the medical records of 353 patients who died of a subarachnoid hemorrhage (SAH) and who were submitted to autopsy over the last 10 years. SAH was associated with arterial hypertension in 180 (51%) cases, with ruptured aneurysms in 102 (28.9%), and with other pathologies in 71 (20.1%). The patients with hemorrhage associated with arterial hypertension were mostly males, and those with hemorrhage due to aneurysms were mostly females. Of the patients with aneurysms, 36 (35.3%) had aneurysms in the anterior communicating artery, 30 (29.4%) in the internal carotid artery, and 23 (22.6%) in the middle cerebral artery. Among the patients with aneurysms who suffered rebleeding and vasospasm, 59.1% and 61.5%, respectively, were classified as grade I and II upon admission, and all evolved toward grade IV after these complications. Vasospasm predominated from the 3rd to the 10th day after hemorrhage, and rebleeding from the 9 to 16th day and both were most frequent among patients with aneurysms of the anterior communicant artery. Sixty eight percent of the patients with aneurysms died during the first 9 days after hemorrhage. Because of our conduct was to operate systematically late, a considerable number of patients lost the opportunity to be treated surgically with possible favorable evolution due to vasospasm or rebleeding.     

Trends in surgical and management outcomes in patients with aneurysmal subarachnoid hemorrhage in Izumo city, Japan, between 1980-1989 and 1990-1998

BACKGROUND AND PURPOSE: The purpose of this community-based study was to evaluate temporal changes in surgical and management outcomes in patients with aneurysmal subarachnoid hemorrhage (SAH). METHODS: The subjects were 358 patients with aneurysmal SAH who were treated during the 19-year period from 1980 to 1998 in Izumo City, Japan. We compared data during the 9-year period 1990-1998 (period B; 188 patients) with those during the 10-year period 1980-1989 (period A; 170 patients). RESULTS: The proportion of patients 80 years of age or older or those with World Federation of Neurosurgical Societies grade V increased significantly (period A, 5 and 25%; period B, 18 and 35%, respectively). The operability rate did not change for patients 69 years of age or younger, whereas it increased significantly for those 70-79 years of age (period A, 48%; period B, 72%). The 6-month and 2-year case fatality rates in surgically treated patients decreased significantly (period A, 12 and 20%; period B, 2 and 8%, respectively), whereas they were virtually unchanged for overall management (period A, 41 and 46%; period B, 38 and 42%, respectively). In patients who underwent surgery, the incidence of permanent symptomatic vasospasm decreased from 21% during period A to 11% during period B, and there was no death from vasospasm in the later period. However, no significant difference was found in the functional outcome between the two periods, regardless of whether surgery was performed. The most important determinants of 6-month and 2-year survival rates were grade on admission, rebleeding and the site of the ruptured aneurysms. Age was also a significant predictor of the 6-month case fatality rate. CONCLUSIONS: For patients with SAH who underwent surgery, there were trends towards decreases in the case fatality rate and in the incidence of permanent symptomatic vasospasm. Nevertheless, the overall management outcome was still unsatisfactory, mainly because of increasing numbers of very elderly and/or high-risk patients. .     

腰椎穿刺脑脊液置换对不同H-H分级蛛网膜下腔出血预后的影响

目的 探讨腰椎穿刺脑脊液置换对不同H-H分级动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage, aSAH)患者迟发性脑血管痉挛发生率及入院90 d预后的影响。方法 回顾性纳入接受颅内动脉瘤栓塞术的aSAH患者,所有患者均与入院3 d内行脑动脉瘤弹簧圈栓塞; 依据H-H分级是否≥Ⅲ级将患者分类后分别对这两类患者按照治疗方案分为脑脊液置换组和非脑脊液置换组。Ⅰ和Ⅱ级aSAH患者中非脑脊液置换组42例,脑脊液置换组46例; ≥Ⅲ级患者非脑脊液置换组53例,脑脊液置换组56例,比较脑脊液检查、颅内感染发生率、迟发性脑血管痉挛发生率、住院时间及入院90 d预后。结果 Ⅰ和Ⅱ级aSAH患者非脑脊液置换组与脑脊液置换组比较,迟发性脑血管痉挛发生率、住院时间及入院90 d预后均无明显差异(P均>0.05); ≥Ⅲ级患者迟发性脑血管痉挛发生率非脑脊液置换组(28.3%)明显高于脑脊液置换组(10.7%)χ²=5.415,P=0.020),且住院时间明显延长(t=2.231,P=0.045),预后较差χ²=4.380,P=0.036)。两类患者中非脑脊液置换组与脑脊液置换组颅内感染率均未见明显增加,且无明显差异(P>0.05)。结论 腰椎穿刺脑脊液置换能够减少≥Ⅲ级蛛网膜下腔出血患者迟发性脑血管痉挛发生率,缩短住院时间,改善患者预后,但不能改善Ⅰ和Ⅱ级蛛网膜下腔出血患者入院90 d预后。     

An Examination of Aneurysm Rerupture Rates with Epsilon Aminocaproic Acid

Background

Epsilon aminocaproic acid (EACA) has been used in the past to prevent cerebral aneurysm rerupture. Recent studies have indicated that short-term treatment with EACA can lower rebleeding rates without significantly increasing ischemic or thrombotic complications or permanent shunt rates. The goal of this study is to determine the efficacy of EACA in the prevention of aneurysm rerupture at a high volume subarachnoid hemorrhage center.

Methods

We conducted a retrospective study of 355 consecutive subarachnoid hemorrhage patients over a 2-year period under our current protocol for EACA use. Patients were divided by presentation time to our institution and whether the patient received EACA. The primary endpoints of the study were rebleeding rates, ischemic complications, thrombotic complications, vasospasm, shunt rates, and outcomes.

Results

Rerupture rates were reduced by half in the entire pool of patients on EACA after controlling for Hunt and Hess Scores and Fisher Scores. In patients who received early aneurysm treatment, this effect persisted but was non-statistically significant due to the small numbers of reruptures. In addition, there was no evidence to suggest that EACA increased ischemic or thrombotic complications, vasospasm, or VPS rates. In patients presenting earlier than 24 h to our institution, there was a non-significant trend toward worse outcomes after EACA use. This trend was reversed in patients arriving after 24 h.

Conclusion

There is evidence to suggest that EACA is protective from aneurysm rerupture without significant ischemic or thrombotic complications when used for less than 72 h. However, if the aneurysm is treated, this effect is modest indicating that early aneurysm treatment remains the gold standard for rerupture prevention.     

Results of the surgical treatment of patients with single aneurysms of the middle cerebral artery

Results are presented of surgical treatment of patients with isolated aneurysms on the middle cerebral artery on the basis of the material of the Department of Neurosurgery, Medical Academy in Warsaw in the years 1975-1981. The material included 161 surgically treated patients out of 179 treated in this time period for diagnosed isolated aneurysm of this artery. The frequency of this aneurysm was 23.2% in this material. The operative mortality was 8.9%, and the results were very good and good in 85.7% of cases. The number of past bleedings from the aneurysm, the clinical state of the patients, the timing of the operation, presence of intracerebral haematoma, intraoperative rupture of the aneurysm and postoperative vasospasm were factors having a significant unfavourable influence on the early postoperative results. Vasospasm was the most frequent postoperative complication observed in 15.2% of cases. The clinical state of the patient and the mode of aneurysm management had a statistically significant effect on the late results of surgical treatment. In 6 cases (6.1%) subarachnoid bleeding appeared after the operation and in 5 of them aneurysm wall had to be strengthened (wrapping).