Emergency surgical management for prevention of symptomatic vasospasm and normal pressure hydrocephalus after subarachnoid hemorrhage due to ruptured cerebral aneurysm

Introduction

Various pieces of research have been done on prevention or treatment of symptomatic vasospasm and normal pressure hydrocephalus after subarachnoid hemorrhage due to ruptured cerebral aneurysm. However, this important issue is still unresolved. In this preliminary report, we introduce our surgical strategy and techniques of subarachnoid hemorrhage due to ruptured cerebral aneurysm and discuss the prevention of symptomatic vasospasm and normal pressure hydrocephalus in the surgical aspect.

Methods

The subjects consisted of 19 consecutive patients with subarachnoid hemorrhage due to a ruptured cerebral aneurysm who were surgically treated in acute stage between 2006 and 2007. All aneurysms were located at the anterior circulation. Hunt & Kosnik classifications were 1 to 3, WFNS were 1 or 2, and the Fisher group was 2 or 3. We performed neck clipping of the aneurysm through the lateral supraorbital or pterional approach. We opened surrounded cisterns of the Circle of Willis and removed the hematoma as much as we could. The lamina terminalis was routinely opened during the operation. We did not insert any drainage tube postoperatively.

Results

Symptomatic vasospasms were noted in four patients. However, the symptoms were not severe and were transient in all patients. There were no patients with normal pressure hydrocephalus. The clinical outcomes were good or excellent. There were almost no perioperative complications due to surgical procedures.

Conclusion

The surgical techniques with certain contributions might prevent symptomatic vasospasm and normal pressure hydrocephalus after subarachnoid hemorrhage due to a ruptured cerebral aneurysm. An accumulation of cases is necessary.