Early treatment of subarachnoid hemorrhage after preventing rerupture of an aneurysm

K. Kinugasa, I. Kamata, N. Hirotsune, K. Tokunaga, K. Sugiu, A. Handa, H. Nakashima, T. Ohmoto, S. Mandai, Y. Matsumoto

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Abstract

Twelve patients with Hunt and Hess neurological Grades III to V underwent thrombosis of aneurysms using cellulose acetate polymer within 23 hours of aneurysm rupture. On computerized tomography (CT), nine of these patients had diffuse or localized thick subarachnoid blood clots, two had diffuse thin clots, and one had intraventricular clots. Immediately after thrombosis, all patients were administered tissue plasminogen activator (TPA) through spinal or ventricular catheters. The pressure of the lumbar cerebrospinal fluid was maintained at 100 to 150 mm H2O. The TPA was given as multiple injections of 2 mg on Day 0 and 1 to 2 mg on the following 1 to 2 days. In two patients the second injection of TPA was not given because of severe brain damage resulting from the initial subarachnoid hemorrhage. Ten patients showed complete clearance of the cisternal clot on CT within 72 hours after thrombosis. Seven partially thrombosed aneurysms and five multiple aneurysms were clipped during delayed surgery. Only one patient experienced mild vasospasm as shown on the follow-up angiogram. Eight patients improved clinically and had a good recovery, two had severe disability, and two died. Urgent thrombosis of a ruptured aneurysm followed by immediate postthrombotic administration of TPA may be a safe and reasonable means of preventing vasospasm and improving patient outcome.

Original languageEnglish
Pages (from-to)34-41
Number of pages8
JournalJournal of neurosurgery
Volume83
Issue number1
DOIs
Publication statusPublished - Jan 1 1995

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Keywords

  • cellulose acetate polymer
  • cerebral vasospasm
  • cerebrospinal fluid drainage
  • delayed aneurysm surgery
  • hypertensive hypervolemic therapy
  • tissue plasminogen activator

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Kinugasa, K., Kamata, I., Hirotsune, N., Tokunaga, K., Sugiu, K., Handa, A., Nakashima, H., Ohmoto, T., Mandai, S., & Matsumoto, Y. (1995). Early treatment of subarachnoid hemorrhage after preventing rerupture of an aneurysm. Journal of neurosurgery, 83(1), 34-41. https://doi.org/10.3171/jns.1995.83.1.0034