COOPERATIVE STUDY OF INTRACRANIAL ANEURYSMS AND SUBARACHNOID HEMORRHAGE Report on a Randomized Treatment Study . Intracranial Surgery

559 Introduction 559 Clinical Material 562 Site of Aneurysm, Interval From SAH to Randomization 563 Treatment Followed According to Protocol 564 Age and Neurological Condition Related to Mortality 565 Age and Medical Condition Related to Mortality 569 Mortality With Respect to Neurological Condition and Interval From Lait Bleed to Surgery 572 Rebleeding Prior to Surgery 575 Cerebral Angiography 576 Complications 576 Associated Lesions 577 Cerebral Vasospasm 577 Introduction 577 Results 578 Mortality and Vasospasm 579 Age and Cerebral Vasospasm 579 Neurological Condition and Cerebral Vasospasm 579 Interval From Last Bleed to Initial Angiography 580 Systolic Blood Pressure and Vasospasm 580 Mean Blood Pressure 581 Size of Aneurysm (mm) and Vasospasm 581 Surgical Techniques 582 General Remarks 582 Brain Resection 582 Vessel Occlusion 582 Removal of Bone Flap 583 Type of Surgical Procedure 583 Multiple Operations 585 Surgical Adjuncts 586 Agents to Reduce Intracranial Pressure 586 Introduction 586 None Utilized 586 Hyperventilatlon 587 Strok: Vol. 5, July-Augvtt 1974 5 5 7 by gest on Sptem er 2, 2017 http://strhajournals.org/ D ow nladed from Mannltol 587 Urea 587 Dexamethasone 587 Spinal Drainage 587 Discussion 588 Hypothermia 588 Other Ad|uncts 589 Hypotension 589 Morbidity 589 Introduction 589 Coma 590 Hemlplegla 591 Hemlparesis 592 Aphasia 593 Confusion and Dementia 593 Miscellaneous Complications 594 Rebleeding After Definitive Surgical Procedure 595 Rupture of Aneurysm During Operation 595 Mortality in Various Centers 595 Discussion 597 Summary 600 References 601 S 5 8 Strok; Vol. 5, July-August 1974 by gest on Sptem er 2, 2017 http://strhajournals.org/ D ow nladed from Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage Report on a Randomized Treatment Study . Intracranial Surgery BY CARL J. GRAF, M.D.,* AND DONALD W. NIBBELINK, M.D.t Abstract: / / / Intracranial Surgery • A group of 274 patients with a single intracranial aneurysm was randomly allocated to intracranial surgery. Forty patients had no surgical procedure. Only six had a vertebral-basilar aneurysm. The remaining 228 patients had an aneurysm on the anterior portion of the circle of Willis. Mortality during the six and one-half-year interval was 36.8%. When the operation was performed within 14 days following the last bleed, mortality was 44.5%; for those operated upon after the 14-day interval mortality was 23.2%. Postoperative complications occurred in 47.8%. / / / Intracranial Surgery • A group of 274 patients with a single intracranial aneurysm was randomly allocated to intracranial surgery. Forty patients had no surgical procedure. Only six had a vertebral-basilar aneurysm. The remaining 228 patients had an aneurysm on the anterior portion of the circle of Willis. Mortality during the six and one-half-year interval was 36.8%. When the operation was performed within 14 days following the last bleed, mortality was 44.5%; for those operated upon after the 14-day interval mortality was 23.2%. Postoperative complications occurred in 47.8%. Additional