Ruptured intracranial aneurysms: the preoperative management and the timing of surgery.

The authors review 179 consecutive cases of ruptured intracranial aneurysms: 80 out of the first 101 patients underwent aneurysm surgery in a period ranging from 7 days to 2 weeks following subarachnoid haemorrhage (SAH) and patients with all grades of the Hunt and Hess classification were included without discrimination. The total case mortality rate was 23%. The postoperative mortality rate was 16%. Of the 78 patients in the 2nd group, 44 cases were operated upon. All patients with grades I, II and III and five cases with IV and V underwent aneurysm surgery. The timing of surgery was established on the basis of the various clinical and biochemical data, especially the improvement of meningeal signs, and decreased sensitivity of cerebral vessels to vasoconstriction. In this group the angiographic vasospasm and focal neurological deficits, without further clinical damage, were not considered a risk for surgery. The surgical mortality rate was 7%. The evidence presented indicates that both a more selective method of assessing the preoperative neurological function and also an appropriate timing of surgery have improved the surgical morbidity and mortality.

Cyclic AMP excretion in urines of patients with subarachnoid hemorrhages.

Urinary excretion of cAMP was closely monitored for several days in 74 patients with subarachnoid hemorrhages. A rise in urinary cAMP up to 45 microM/24h was observed (normal values being 1 to 5 microM/24h). Patients with associated metabolic disorders were excluded from this study. We have found a correlation between the severity of the clinical conditions, recovery from acute disorder and cAMP excretion, thus suggesting that an increase of urinary cAMP level is related to the extent and the evolution of the acute cerebral damage.

Considerations on the origin of subarachnoid hemorrhages.

The Authors emphasize the importance of C.T. in the study of subarachnoid hemorrhages. By means of this new radiological investigation they are able to exclude a vascular or tumoral etiology in those patients who had no aneurysms detectable by cerebral angiography, and suggest the problem of the so-called spontaneous subarachnoid hemorrhages. They discuss the degenerative nature of the endocranial aneurysms. Several interesting case-reports stress the importance of the primitive lesions of the arterial wall vessel in the degenerative origin of endocranial aneurysms.

Treatment of carotid-cavernous sinus fistula by the Fogarty catheter.

Four cases of CCF treated by embolization of the carotid by Fogarty catheter are reported. The results were excellent in three patient and good in one.