Emergent Aneurysm Surgery without Cerebral Angiography for the Comatose Patients with ICH or SDH

ABSTRACT

Neurologically based clinical grading scales offer excellent prognostic information for the patient suffering diffuse subarachnoid hemorrhaging. These grading scales are less applicable to patients with life-threatening intraparenchymal or subdural hematomas after aneurysmal rupture. During 2 and half years, 9 patients(ICH;5,SDH;1, ICH+SDH;3) in a comatose state with brain stem compression syndromes documented by computerized tomographic scans have undergone emergent operation without angiography in our neurosurgical department. Each patient was so critically ill that we believed it unwise to delay craniotomy for diagnostic angiography. The average delay from the detection to operation was 2 hours. The origin of the hematoma was identified as a berry aneurysm of the middle cereral artery bifurcation in seven patients and a posterior communicating artery aneurysm in two patients. One patient had a good recovery, two patients reovered with hemiparesis and mild cognitive dysfunction, two patients were vegetative and died due to pneumonia, and four patients died due to brain swelling within two weeks postoperatively. Emergent craniotomy with empiric exploration of appropriate subarachnoid cisterns after hematoma decompression may be life-saving management in some cases. The delay imposedfor diagnostic angiography may be avoided in attempts to save vital minutes of severe brain stem compression.