A prospective study on the effects of early surgery on vasospasm after subarachnoid hemorrhage

BACKGROUND To test the hypothesis that early surgery prevents vasospasm, a prospective analysis used strictly selected cases of anterior communicating artery ane urysms with symmetric distribution of subarachnoid hemorrhage. METHODS Seven patients underwent early surgery (9-29 hours after ictus) through a s tandard pterional approach. Subarachnoid blood clots surrounding the ipsila teral major cerebral arteries were meticulously irrigated and suctioned. Co mparison was made between the hemispheres with surgical intervention and th ose without, in terms of incidence of delayed ischemic neurologic deficits and cerebral infarction on computed tomographic scans, degree of angiograph ic vasospasm, and cerebral blood flow (CBF). RESULTS The degree of angiographic vasospasm, quantified by measuring the alteratio ns in the ratio of the diameters of the intracranial arteries (C1, M1) to t he extracranial internal carotid artery (C5), did not differ significantly between the surgical and nonsurgical sides. The mean CBF was also comparabl e between both sides in the chronic spasm phase (Day 6-9) as well as in the early postoperative period (Day 1-3). A significant reduction of CBF was o bserved during the early postoperative period in the basal frontal lobe of the surgical side. This CBF reduction seems to correspond to brain retracti on. CONCLUSIONS The results suggest that the effect of clot removal may be offset by the ne gative aspect of early surgery, and early surgery per se seems to have litt le effect on the course of the chronic vasospasm. (C) 1999 by Elsevier Scie nce Inc.