| Abstract: | That direct intracranial operation in indicated in ruptured intracranial aneurysm which has passed the acute stage is an accepted procedure today. However, regarding the pros and cons of direct intracranial operation during the acute stage, settlement has yet to be made. This arises from the fact that various combined aggravated pathological states of cerebral vasospasm, brain edema, intracerebral hematoma, hydrocephalus etc. are present. The authors had attended to the acute hydrocephalus in the cases of ruptured aneurysm and conducted ventriculoatrial shunt for hydrocephalus actively. As a result, it was found that ventriculoatrial shunt brought about considable improvement of the patients condition to such an extent that an early operation became possible. The results are following: (1) The authors conducted cerebral angiography in the acute stage in 51 cases of ruptured intracranial aneurysm. Of this 51 cases as a result of angiographic findings, 12 cases, 23.5% showed ventricular dilation and accompanied lowering of consciousness level and increased intracranial pressure. (2) The largest number of acute hydrocephalus among our cases appeared in patients in the age level of 30-39, amounting to 44.4%. While this seemed to indicate the importance of the age factor, no correlation was seen with the localization of ruptured intracranial aneurysm or the number of experienced ruptures. (3) Of 12 cases of acute hydrocephalus 7 cases were subjected to ventriculoatrial shunt operations. Of 7 cases, after operation 6 cases showed an improvement in consciousness remarkably, thus making it possible to conduct an early intracranial operation of aneurysm. Ventricular drainage, V-A shunt for the following reasons: 1. Possibility of infection is very few. 2. The site of burr hole for V-A shunt located in parietal area. So craniotomy area, for example bifrontal craniotomy is apart from the site of V-A shunt. 3. The control of intracranial pressure is also easy after intracranial operation for aneurysm. 4. Normal pressure hydrocephalus can be prevented. 5. This method is useful for decreasing the brain bulk during the direct operation. |
