Fifty-two intracranial aneurysms were operated upon with direct approach under the surgical microscope from 1972. Of these, 27 patients (52%) were female. The aneurysms arising in the anterior communicating artery (20) were most common, followed by middle cerebral artery (13), internal carotid artery (8), posterior communicating artery (8) in order.
We almost preferred pterional approach (47 cases) and the timing of operation was scheduled as soon as possible if other condition permitted Ten patient under-went early aneurysmal operation before 96 hours after SAH. There was an in´orbidity of 1207o and no death in patients classified as Hunt and Hess Grade 1 at preoperation, but the overall morbidity of 19.2% and mortality of 17.3% were noted at 4 months after surgery. Results and complications (including preoperative death and morbidity) of the surgical management of these patients were correlated with Hunt and Hess Grade. In early operation, the morbidity and mortality was 20% and 201%, respectively.
To review successful 52 aneurysmal operations, following results were showed.
1) The incidence of aneurymal rupture gradually increases for each,decade, and in female the peak was in sixth decade but in male fifth decade. There was more incidence in male before fifth decade, but in female after sixth decade.
2) Our analysis supports that the early aneurysmal surgery was indicated to the patients of Hunt and Hess Grade 1, 2, those with large intracerebral hematoma or with rebleeding.
3) There was no relationship between the sites of aneurysm and the results of operation, based on our data, but the surgical results were correlated with size of aneurysms.
4) It is imperative that in aneurysmal operation, the brain parenchyma is retracted as less and gently as possible with meticulous hemostasis of micro-oozing from bridging voins and internal dural surface and complete removal of
subaraclhnoid cl()t´s_
5) The h~´perte´i1sive-hypervolemic therapy is effective in treatment of symptomatic cerebral iscl-iemia secondary to aneurysmal surgery.
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