Significance of vasospasm in the treatment of ruptured intracranial aneurysms

Abstract

Cases (96) in which vasospasm followed subarachnoid hemorrhage (SAH) were studied. The SAH was caused by ruptured intracranial aneurysm or developed after aneurysm surgery. Usually at least 4 days elapsed between SAH and the onset of vasospasm. Vasospasm subsided an average of 2 wk after onset. Of 68 patients with preoperative vasospasm, 8 died due to cerebral edema resulting from ischemia, and 49% of the survivors had neurological deficits. Preoperative vasospasm was not aggravated by surgical intervention when operations were carried out more than 7 days after the onset of vasospasm. Postoperative vasospasm was found in 25 of 52 patients who underwent operation within 1 wk after SAH (excluding cases in Grade V). Of these patients, 5 died, all of whom underwent surgery between the 4th and 7th day after SAH (the day of SAH was counted as the 1st day). There were no deaths among 20 patients operated on within the first 3 days after SAH. Postoperative vasospasm was always mild in these cases, when it occurred, probably because blood clot or blood-stained CSF was removed by operative procedures. In all cases, 4-11 days elapsed between the last SAH and the onset of postoperative vasospasm regardless of the timing of surgery.