Factors Affecting Development and Recovery of Symptomatic Vasoapasm in Patients with Ruptured Intracranial Aneurysm(s)

Choi, Seok Min; Suk, Jong Sik; Kwon, Jeong Taik; Min, Byung Kook; Hwang, Sung Nam; Kim, Young Baeg; Hong, Hyun Jong

Abstract

To determine the factors affecting development and recovery of symptomatic vasospasm, the author analyzed the results of patients with ruptured intracranial aneurysms treated by nimodipine and prophylactic "triple-H" therapy. From January 1991 to December 1995, 199 patients underwent surgery for ruptured intracerebral aneurysms. Combined hypervolemic hemodilution was initiated at the time of admission. Induced hypertension was added immediately after surgery(aneurysmal neck clipping). All patients received nimodipine intravenously or orally until the 14th day of SAH. Sixty patients underwent surgery on Day 0 through 2 after attackes of subarachnoid hemorrhage(Group A), 105 patients on Day 3 through 14(Group B), and 34 patients after Day 14(Group C). Of 199 patients, 76(38%) patients suffered from symptomatic vasospasm. Symptomatic vasospasm occurred in 34% of Group A patients, 33% of Group B patients, and 5% of Group C patients. Symtomatic vasospasm occurred more frequently in the older age group, the Fisher group 3, and Hunt & Hess grades 3, 4 and 5 groups. Of 76 patients who suffered from symptomatic vasospasm, 47(62%) patients recovered completely. The author analyzed the relationship between recovery rate and sex, age, Hunt & Hess grade and Fisher group among these 76 patients. Recovery rates between these groups were not significantly different. Based on this experience, the author believes that Hunt-Hess grade, Fisher group, and age are important factors affecting symptomatic vasospasm development.