Summary
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.
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Adams, H. P., Kassell, N. F., Torner, J. C., Nibbelink, D. W., Sahs, A. L., Early management of aneurysmal subarachnoid hemorhhage. A report of the cooperative aneurysm study. J. Neurosurg.54 (1981), 141–145.
Bullin, D. J., Brandt, L., Ljunggren, B., Tagari, P., Vasoconstrictor activity in cerebrospinal fluid from patients subjected to early surgery for ruptured intracranial aneurysms. J. Neurosurg.55 (1981), 237–245.
Davis, J. M., Davis, K. R., Crowell, R. M., Subarachnoid hemorrhage secondary to ruptured intracranial aneurysm: Prognostic significance of cranial CT. AJR134 (1980), 711–715.
Fischer, C. M., Kistler, J. P., Davis, J. M., Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurg.6 (1980), 1–9.
Hammes, E. M., Reaction of the meninges to blood. Arch. Neurol. Psychiat.52 (1944), 505–514.
Hunt, W. E., Miller, C. A., The results of early operation for aneurysm. Clin. Neurosurg.24 (1977), 208–215.
Ito, U., Kito, K., Seida, M., Tomida, S., Inaba, Y., A consideration on cisternal drainage in acute stage aneurysm operation. In: Proceedings of 12th Annual Meeting for Cerebrovascular Surgery, Vol. 12 (Kodama, M., ed.), pp. 125–129. Tokyo: Neuron Sha, 1983 (Japanese with English abstract).
Jackson, I. J., Aseptic hemogenic meningitis. An experimental study of aseptic meningeal reactions due to blood and its breakdown products. Arch. Neurol. Psychiat.62 (1947), 572–589.
Kaneko, M., Hosaka, Y., Koga, H., Experience of per-acute operation for severe type of ruptured intracranial aneurysm. Application of repeated irrigation of basal cisterns. Neurol. Med. Chir.20 (1980), 915–921 (Japanese with English abstract.).
Kassell, N. F., Boarini, D. J., Adams, H. P., Sahs, Á. L., Graf, C. J., Torner, J. C., Gerk, M. K., Overall management of ruptured aneurysms: Comparison of early and later operation. Neurosurg.9 (1981), 120–128.
Kindt, G. W., McGillicudy, J., Prity, M., Giannota, S., Hypertension and hypervolemia as therapy for patients with vasospasm. In: Cerebral Arterial Spasm (Wilkins, R. H., ed.), pp. 659–664. Baltimore-London: Williams & Wilkins. 1980.
Kosnik, E. J., Hunt, W. E., Postoperative hypertension in the management of patients with intracranial arterial spasms. J. Neurosurg.45 (1976), 148–154.
Ljunggren, B., Brandt, L., Kagstroem, E., Sundbaerg, G., Results of early operations for ruptured aneurysms. J. Neurosurg.54 (1981), 473–479.
Miyaoka, M., Nonaka, T., Watanabe, H., Chigasaki, H., Ishii, S., Etiology and treatment of prolonged vasospasm: Experimental and clinical studies. Neurol. Med. Chir. (Tokyo)16 (1976), 103–114 (Japanese with English abstract).
Mizukami, M., Takemae, T., Tazawa, T., Kawase, T., Matsuzaki, T., Value of computed tomography in the prediction of cerebral vasospasm after aneurysm rupture. Neurosurg.7 (1980), 583–586.
Mizukami, M., Kawase, T., Tazawa, T., Prevention of vasospasm by early operations with removal of subarachnoid blood. Neurosurg.10 (1982), 301–306.
Saito, I., Sano, K., Vasospasm after aneurysm rupture; incidence, onset and course. In: Cerebral Arterial Spasm (Wilkins, R. H., ed.), pp. 294–301. Baltimore-London: Williams & Wilkins. 1980.
Sakamoto, T., Kodama, N., Ebina, T., Suzuki, J., Third ventriculostomy for the hydrocephalus after subarachnoid hemorrhage. Noshinkeigeka (Tokyo)6 (1978), 1071–1075 (Japanese with English abstract).
Samson, D. S., Hodosh, R. M., Reid, W. R., Beyer, C. W., Clark, W. K., Risk of intracranial aneurysm surgery in the good grade patient: Early versus later operation. Neurosurg.5 (1979), 422–426.
Sano, K., Saito, I., Timing and indication of surgery for ruptured intracranial aneurysms with regard to cerebral vasospasms. Acta Neurochir. (Wien),41 (1978), 49–60.
Sato, J., Sato, O., Kamitani, I., Kanazawa, I., Kokunai, T., Intracranial surgery and operative management of patients with ruptured aneurysm in acute and subacute stage. Basal cistern drainage and lumbar subarachnoid drainage. Neurol. Med. Chir.19 (1979), 173–179 (Japanese with English abstract).
Scarf, J. E., Treatment of obstructive hydrocephalus by puncture of the lamina terminalis and floor of the third ventricle. J. Neurosurg.8 (1951), 204–213.
Shiobora, R., Toya, S., Lisaka, Y., Shizawa, H., Ichizaki, K., An evaluation of the continuous ventricular drainage for ruptured cerebral aneurysms: Treatment of postoperative increased ventricular fluid pressure. Neurol. Med. Chir.17 (1977), 145–152 (Japanese with English abstract).
Sonobe, M., Takahashi, S., Otsuki, T., Kubota, Y., Preventive effect on intracranial arterial vasospasm using combined ventriculo-cisternal and cisternal drainage. Neurol. Med. Chir.9 (1981), 1393–1397 (Japanese with English abstract).
Suzuki, J., Onuma, T., Yoshimoto, T., Results of early operations on cerebral aneurysms. Surg. Neurol.11 (1979), 407–412.
Symon, L., The incidence and onset of vasospasm after subarachnoid hemorrhage. In: Cerebral Arterial Spasm (Wilkins, R. H., ed.), pp. 306–307. Baltimore-London: Williams & Wilkins. 1980.
Takahashi, S., Sonobe, M., Nagamine, Y., Early operations for ruptured intracranial aneurysms. Comparative study with computed tomography. Acta Neurochir. (Wien)57 (1981), 23–31.
Taneda, M., The significance of early operation in the management of ruptured intracranial aneurysms. An analysis of 251 cases hospitalized within 24 hours after subarachnoid hemorrhage. Acta Neurochir. (Wien)63 (1982), 201–208.
Vapalahti, M., Ljunggren, B., Saeveland, H., Hernesniemi, J., Brandt, L., Tapaninaho, A., Early aneurysm operation and outcome in two remote Scandinavian populations. J. Neurosurg.60 (1984), 1160–1162.
Yamamoto, I., Hara, M., Ogura, K., Suzuki, Y., Nakane, T., Kageyama, N., Early operation for ruptured intracranial aneurysms. Comparative study with CT. Neurosurg.12 (1983), 169–174.
Yaşargil, M. G., Yonekawa, Y., Zumstein, B., Stahl, H. H., Hydrocephalus following spontaneous subarachnoid hemorrhage. J. Neurosurg.39 (1973), 477–479.
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Ito, U., Tomita, H., Yamazaki, S. et al. Enhanced cisternal drainage and cerebral vasospasm in early aneurysm surgery. Acta neurochir 80, 18–23 (1986). https://doi.org/10.1007/BF01809552
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DOI: https://doi.org/10.1007/BF01809552