Enhanced cisternal drainage and cerebral vasospasm in early aneurysm surgery.
Enhanced cisternal drainage was performed following early aneurysm surgery in patients with Hunt and Kosnik grades I-III, to effect continuous wash-out of subarachnoid blood clots and reduce symptomatic vasospasm. Following extensive evacuation of the cisternal blood clots, the Liliequist's membrane was opened extensively and a third ventriculostomy was effected by opening the lamina terminals. The drainage effect was considered as poor, moderate or fair, depending on the average amount of CSF drainage/day. SAH was graded into 0-III depending on the severity of cisternal haematoma in the pre-operative CT. No symptomatic vasospasm occurred in patients with SAH grade I. In SAH grade II + III patients symptomatic vasospasm occurred in 78, 60 and 42% of patients with a poor, moderate and fair drainage effect, respectively. Nine patients who developed symptomatic vasospasm were treated by hypertensive/hypervolemic therapy (HHT). The HHT was effective in 7 patients with fair and moderate CSF drainage and ineffective in 2 patients with poor a drainage effect. It seems, that enhanced post-operative cisternal drainage can reduce the incidence of symptomatic vasospasm and be of benefit to the outcome of early aneurysm surgery.
U
U
Ito
H
H
Tomita
S
S
Yamazaki
Y
Y
Takada
Y
Y
Inaba
D001794:Blood Pressure; D002552:Cerebral Ventricles / Q000601:surgery; D002557:Cerebrospinal Fluid Shunts; D002946:Cisterna Magna / Q000601:surgery*; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D002546:Ischemic Attack, Transient / Q000209:etiology* / Q000628:therapy; D011183:Postoperative Complications / Q000209:etiology* / Q000628:therapy; D012422:Rupture, Spontaneous; D013345:Subarachnoid Hemorrhage / Q000601:surgery*