[Analysis of 223 cases of intracranial aneurysms--with special reference to re-rupture of the intracranial aneurysms]

Reviewing 223 cases of intracranial ruptured aneurysms including 46 cases of re-ruptured aneurysms, the following results were obtained. 1) The outcome of the re-rupture aneurysms was more miserable than that of the first rupture. Even low grade cases (Hunt and Hess 0-II) of re-rupture showed no better outcome than high grade cases (Hunt and Hess IV) of first rupture. 2) Re-rupture most often occurred on the 12th (11.6 +/- 6.7) day after the first attack of the subarachnoid hemorrhage. Re-rupture more often occurred in the vertebrobasilar system. In the internal carotid artery and its branches, aneurysms with daughter or bleb tended to rupture again. Aneurysms with daughter, regardless of these location, showed greater incidence of re-rupture than those without daughter. Also rupture often occurred in the cases of lower grade with less vasospasm and with the acute hydrocephalus. 3) It was suggested that the sequential changes of some factors of both the coagulating system and fibrinolytic system might forecast the vasospasm, infarction, re-rupture and prognosis of the patient of intracranial ruptured aneurysms. And therefore, in the cases in which re-rupture is likely, operation should be performed as early as possible, except in those showing diffuse vasospasm or clinical down hill course or in grade V.