[Vasospasm and its outcome after early surgery for ruptured cerebral aneurysms: changing pattern of its incidence and outcome during this 9-year period].
The occurrence and outcome of vasospasm (VS) were analyzed in 240 patients who had aneurysm surgery within 7 days of a hemorrhage during 9-year period (1981-89). Occurrence of VS was evaluated by the appearance of ischemic symptoms, (A) with or (B) without CT evidence of infarcts. The surgical outcome was assessed by the Glasgow Outcome Scale 6 months postoperatively. The results in the first and the latter halves of the period were compared. The overall incidence of VS (A+B) was 34.8% (A: 23.5%, B: 11.3%) and 33.6% (A: 15.2%, B: 18.4%) in the first and the latter halves, respectively. Thus, VS leading to infarction showed a tendency to decrease in the latter half of the period, though the overall incidence of VS itself was almost identical in both the first and second halves of the period. The results were also analyzed according to preoperative grading based on the Glasgow Coma Scale (GCS). The tendency toward decreased severity of VS in the latter term was most remarkable in patients with GCS total scores between 14 and 13. The decreased incidence of severe VS proved to be reflected in decreased mortality and in increased rate of good outcome in the latter half of the period. In order to confirm whether the results obtained in our clinic are universal, we applied the same analysis for control groups in four cooperative double-blind clinical trials performed during this period in Japan. The study again showed that the rate of infarction has decreased significantly over the decade, resulting in the improved surgical outcome.(ABSTRACT TRUNCATED AT 250 WORDS)
Gotoh
O
O
Department of Neurosurgery, Teikyo University School of Medicine.
Tamura
A
A
Nihei
H
H
Manaka
S
S
Tsujita
Y
Y
Oka
H
H
Sano
K
K
D002544:Cerebral Infarction / Q000453:epidemiology; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery*; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000209:etiology*; D007564:Japan / Q000453:epidemiology; D008875:Middle Aged; D011379:Prognosis; D013345:Subarachnoid Hemorrhage / Q000601:surgery; D016896:Treatment Outcome