|
KMID : 0360919710140010048
|
|
Journal of the Korean Medical Association
1971 Volume.14 No. 1 p.48 ~ p.66
|
|
|
CLINICAL OBSERVATION AND SURGICAL TREATMENT OF INTRACRANIAL ANEURYSMS
|
|
áäòååé/Song, Jin Un
ÑÑܹñç/ì°çµÐÆ/õËÓìçµ/õËóãÕ¦/Ë©ñÕÐñ/áäíâà÷/Kim, Byung Joon/Lee, Yung Keun/Choi, Duk Yung/Choi, Chang Rak/Kang, Joon Kee/Song, Jang Sung
|
|
|
Abstract
|
|
|
We have experienced 60 cases of the intracranial aneurysms with subarachnoid hemorrhage who were admitted to the Presbyterian Hospital, Taegu from January 1965 to July 1968 and to Catholic Medical Centre, Seoul from August 1968 to September 1970.
All of the cases were proved to have aneurysm by cerebral angiography. Since the clinical manifestations were considered to have close relation to the prognosis and the result of surgery,. various analysis of the clinical manifestations were attempted.
Of the 60 cases, surgery were performed on 36 cases and its mortality was analyzed correlating to clinical conditions.
Followings are the results.
1. Age distribution of the ruptured intracranial aneurysms was ranged from 20 to 70 and 41% of them were in 4th decade.
2. Most common site of the aneurysms was the anterior communicating artery (43%), 30% of the aneurysms located on the internal carotid artery, 16% on middle cerebral artery, 8% on anterior cerebral artery and 1% on basilar artery.
3. In the past history, hypertension was noted in 21% of them, and 16% of cases had frequent headache. Repeated hemorrhages were seen in 37% and rebleedings of the aneurysms were noted mostly within 3 weeks from the 1st attack.
4. Site of the headache suffering from primary subarachnoid hemorrhage due to ruptured intracranial aneurysms was the generalized one in 71% and all cases of the posterior communicating aneurysm showed periorbital and/or facial pain. It seemed no close relation between the site of aneurysm and that of headache except the posterior communicating aneurysm.
About 70% of the cases lost consciousness at the onset of bleeding and unconsciousness was less common with the internal carotid aneurysm.
5. After the rupture of the aneurysm, persistent hypertension was noted in 11% and transient hyper tension was found in 30% of the cases in which the blood pressure returned to normal with absolute bed rest for days or a week.
6. Cranial nerve palsies were present in 18% of the cases of which the 3rd nerve palsy was the most frequent sign with the aneurysm of posterior communicating artery.
Papiiledema was noted in 20% of the cases.
The aneurysms of the anterior communicating artery were more apt to produce motor deficit than those of the middle cerebral arteries.
Speech dysf unction was noted in 5% of cases.
7. Neurological conditions of the cases regarding the Botterell¢¥s classification revealed 55% were in Group I, 18% in ¥±, 18% in ¥² and 8% ¥³ N and ¥´.
8. The measurements of aneurysm size in angiograms showed 76% in 5mm~10mm and 5% over 10mm, 13% under 5mm in their diameter respectively. There was no arterial spasm in 46% of the cases and diffusespasm in 20%. Only 1 case showed the space taking evidence in angiogram and intracerebral hematoma of the frontal lobe was proved in the surgery of anterior communicating aneurysm.
Referring to the Okawara¢¥s classification for the, type of anterior circulation of circle of Willis, 38% was considered in type ¥°, 15% in ¥±, 11% in ¥² and ¥³respectively and 23% in ¥´.
9. Analyzing the surgical result, it was thought that presence of hypertension, size of the aneurysm and presence of diffuse arterial spasm has the intimate relation to the operative mortality. In the cases of-surgery which was carried in a week from the last hemorrhage, mortality rate was high.
The number of hemorrhages did not influence the-direct operative mortality, but in non-surgical cases, repeated hemorrhage was thought to have definite influence to the mortality.
10. The mortality of intracranial surgery for aneurysms was 11% in Botterell¢¥s Group ¥° cases, 20% ins Group ¥± and ¥² cases, and in Group ¥³ and ¥´ removal hematoma could not save the patient. Proximal ligation of the anterior cerebral artery was performed in the 9 cases of type ¥² and ¥´ of Okawara¢¥s classification successfully but in a case of the type I , it was failure and the patient was expired.
11. Hydrocephalus due to obstruction of cerebrospinal fluid flow in the basal cistern as a sequela of, the ruptured intracranial aneurysm¢¥ was seen in 5%, of the cases.
|
|
|
KEYWORD
|
|
|
|
|
|
FullTexts / Linksout information
|
|
|
|
|
|
Listed journal information
|
|
|
|
|