Surgical treatment of aged patients with ruptured cerebral aneurysm; evaluation of the operations performed without using retractors
Horimoto, C.; Tsujimura, M.
No Shinkei Geka. Neurological Surgery 20(5): 553-557
1992
ISSN/ISBN: 0301-2603 PMID: 1598131 Document Number: 392459
Sixteen patients over 70 years of age with ruptured cerebral aneurysms in the anterior circulation were surgically treated via the pterional approach. Self-retaining brain retractors (SRBRs) were used in seven patients (Group A), but not in nine other patients (Group B). On admission there were no significant differences between the groups in terms of the neurological grading of Hunt and Kosnik or the CT grading of Fisher. The timing of the operation was decided on the basis of the neurological grading of Hunt and Kosnik and the systemic complications present in each case. Early operation (within 2 days) was performed in 10 cases (5 cases in each group), whereas delayed operation (after 15 days) was carried out in 6 cases (Group A: 2 cases; Group B: 4 cases). Symptomatic vasospasm occurred in 43% of Group A and in 33% of Group B. Postoperative CT scans showed new or aggravated brain edema in the fronto-temporal region (the site of craniotomy) in 3 Group A cases, but not in any Group B cases. By means of technetium-99m-labeled hexamethylpropyleneamine oxime single photon emission computed tomography (SPECT) the regional cerebral blood flow (CBF) in the fronto-temporal region of the operated side was studied in 6 patients (3 cases in each group) one day after and three months after the operation. One day after the operation, the regional CBF in the fronto-temporal region had decreased in the three Group A cases, but no changes were observed in the three Group B cases. Three months after the operation the regional CBF impairment had improved in 2 of the Group A cases. Based on the Glasgow outcome scale, at the time of discharge, the overall outcome in Group A and Group B were about the same with regard to moderate disability, severe disability, vegetative state and death. However good recovery was observed only in Group B, in which there had been no impairment of the regional CBF on SPECT, and no increase in brain edema on the post operative CT scan. It is surmised that the operation without using retractors provides good results in aged patients with ruptured cerebral aneurysms.