title: A prospective study on the effects of early surgery on vasospasm after subarachnoid hemorrhage.
abstract: BACKGROUND
  To test the hypothesis that early surgery prevents vasospasm, a prospective analysis used strictly selected cases of anterior communicating artery aneurysms with symmetric distribution of subarachnoid hemorrhage.
  
  
  METHODS
  Seven patients underwent early surgery (9-29 hours after ictus) through a standard pterional approach. Subarachnoid blood clots surrounding the ipsilateral major cerebral arteries were meticulously irrigated and suctioned. Comparison was made between the hemispheres with surgical intervention and those without, in terms of incidence of delayed ischemic neurologic deficits and cerebral infarction on computed tomographic scans, degree of angiographic vasospasm, and cerebral blood flow (CBF).
  
  
  RESULTS
  The degree of angiographic vasospasm, quantified by measuring the alterations in the ratio of the diameters of the intracranial arteries (C1, M1) to the extracranial internal carotid artery (C5), did not differ significantly between the surgical and nonsurgical sides. The mean CBF was also comparable between both sides in the chronic spasm phase (Day 6-9) as well as in the early postoperative period (Day 1-3). A significant reduction of CBF was observed during the early postoperative period in the basal frontal lobe of the surgical side. This CBF reduction seems to correspond to brain retraction.
  
  
  CONCLUSIONS
  The results suggest that the effect of clot removal may be offset by the negative aspect of early surgery, and early surgery per se seems to have little effect on the course of the chronic vasospasm.
authors: Department of Neurosurgery, Dokkyo University School of Medicine, Koshigaya Hospital, Saitama, Japan.
authors: Y
authors: Y
authors: Yoshimoto
authors: S
authors: S
authors: Wakai
authors: A
authors: A
authors: Satoh
authors: T
authors: T
authors: Tejima
authors: M
authors: M
authors: Hamano
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications*; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D018579:Patient Selection; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome