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Journal of Korean Neurosurgical Society 1976;5(2): 75-90.
Clinical Analysis of 158 Surgically Treated Intracranial Aneurysms.
Hun Jae Lee, Yoon Sun Hahn, Kyu Chang Lee, Sang Sup Chung, Young Soo Kim, Sang Kun Park
Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.
The author analyzed 158 cases of intracranial aneurysm surgically treated in the Department of Neurosurgery, Yonsei University Medical College, from Jan. 1965 to Sept. 1976. Of the 158 cases 124 underwent direct intracranial approach (clipping, ligature, coating, wrapping, proximal vessel occlusion, and trapping) for the treatment of the aneurysms, and 33 cases underwent proximal carotid ligation in the neck as the choice of treatment. The aneurysms arising in the posterior communicating artery (46) are most common, followed by anterior communicating artery (43), middle cerebral artery M2 portion (22), and carotid bifurcation (12) in order. We also found cavernous aneurysm (2), ophthalmic artery aneurysms (3), anterior choroidal artery aneurysm (2), anterior cerebral artery A1 portion aneurysm (6), distal anterior cerebral artery aneurysm (2), middle cerebral artery M1 portion aneurysm (8), m3 portion aneurysm (2), posterior cerebral artery aneurysm (1) and basilar artery aneurysm (1). Multiple aneurysms were found in 8 cases. There was no significant difference according to sex. There were 18 cases over 60 years of age, of whom 2 were 75 years old. On this basis, we cannot consider ligation was 18.2%. If patients who were operated on in emergency because of large intracranial hematoma of repeated, or chain rupture of aneurysm are excluded, the mortality rate for purely elective cases using the intracranial approach drops to 4.3%. After introduction of the surgical microscope and newly designed temporary clipping system, 37 patients were operated on with only one death (2.7%), a patient who had repeated ruptures of the posterior communicating artery aneurysm and was operative on only 7 days after the last bleeding. So recently we have not had to pay much attention to the mortality rate of the intracranial attack for the aneurysms. There are instances when imperfection which cannot be seen by the naked eye are noticed only after the aneurysmal neck is magnified from 6 to 40 times with use of microscope. In these cases, it is obvious that correction of clipping as well as coating, which prevents rupture of the aneurysmal sac and reinforces or prevents slipping of the clip are inevitable. Various factors, such as grade of the patient's condition vasospasm, cerebral edema, presence of intracranial hematoma, state of intracranial pressure, preoperative management, timing of surgery, points of operative technique according to the sites of aneurysms, postoperative complications and their management, all of which affect the clinical and postoperative course, are discussed.
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