Clinical significance of computed tomography in early aneurysm surgery.

The significance of computer tomographic findings for the analysis of complications or the course and prognosis after early aneurysm surgery was analyzed on the basis of 100 patients consecutively operated on for ruptured cerebral aneurysms. Intracerebral or extended intraventricular hematomas were a poor prognostic sign. An acute hydrocephalus had a negative effect only on the early course but not on the final results. Nearly all (94) of the patients presented postoperatively with a cerebral volume increase either by CSF release, edema, and/or vasoparalysis. A correlation with the final result could not be observed. Twenty-two patients presented with ischemic infarction in the postoperative CT scan, one had hemorrhagic infarction. In 19 of the 22 cases the cause of the infarction could be related to the surgical trauma. In 10 cases it remained asymptomatic. In only one case vasospasm was responsible for a symptomatic infarction. The findings show that early surgical repair of a ruptured cerebral aneurysm is an effective method to prevent rebleeding and ischemic infarction by vasospasm. The hemorrhage and the operation, however, are followed by a large number of visible morphological lesions in the CT scan.