UNRUPTURED ANEURYSMS ASSOCIATED WITH ISCHEMIC CEREBROVASCULAR DISEASES - SURGICAL INDICATION

Out of 3435 patients with ischaemic cerebrovascular disease 2540 cases were investigated using cerebral angiography. In 127 of them (5%) ane urysms were found, but without clinical evidence of subarachnoid haemo rrhage (SAH). 45 cases were operated upon and 82 were treated conserva tively. Five of these 82 cases (6%) suffered from SAH 3 months to 10 y ears (mean interval 5,6 years) after the angiographic diagnosis. Four of these 5 patients with SAH died. Among the 45 surgical cases follow- up was uneventful in 29 (64%). The other 16 cases postoperatively show ed neurological deterioration (36%), which was transient in 6 but with only minor improvement in 10. Of these 10 cases 2 died from cerebral infarction related to intra-operative temporary vascular occlusion res pectively myocardial infarction. Thus surgical mortality was 4% and pe rmanent morbidity 18%. Causes of postoperative neurological deteriorat ion were partly related to general arteriosclerotic changes and specia l fragility of the ischaemic brain, and partly to operative technique (excessive brain retraction, damage to cortical veins, occlusion of ma jor vessels or damage to perforators, temporary artery occlusion). App arently in cases with ischaemic cerebrovascular diseases operative pro cedures, which in other cases as a rule are well tolerated, may produc e harmful effects. Therefore, in these cases, the indication for opera tive treatment of so far silent aneurysms should be restricted to pati ents who are in good general condition with longer life expectancy as far as the vascular disease is concerned, and without major neurologic al deficit. Furthermore, the operative technique should be especially gentle and atraumatic.