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  • Title: [Supratentorial craniotomy of the cisternal clot removal in cases with ruptured aneurysms in the posterior fossa].
    Author: Niwa J, Kubota T, Okuyama T, Shimizu K, Hirai H.
    Journal: No Shinkei Geka; 1990 Apr; 18(4):385-9. PubMed ID: 2374651.
    Abstract:
    In cases of ruptured aneurysms in the anterior circulation, early surgery and extensive surgical removal of cisternal clot have been proven to effectively prevent rebleeding and vasospasm. However, for aneurysms in the posterior fossa, early surgery has been adopted only by a limited number of surgeons and the effect of clot removal has been rarely discussed. Consequently, prognosis is complicated by rebleeding, and by vasospasm when the basal cistern is occupied by a dense clot. We have performed early surgery for aneurysms in the posterior fossa, but, in some cases, vasospasm in the carotid area has not been able to be prevented. Recently, we succeeded in preventing vasospasm in two cases that would have been unavoidably complicated by vasospasm, by additional craniotomies in the supratentorial region for the removal of cisternal clot. These two cases were in grade IV at operation due to rupture of aneurysms on the vertebral artery and on the AICA meatal loop, with dense clots in the basal cistern. Operations were performed within 24 hours after SAH. They resulted in recovery which was uneventful, and without signs of delayed ischemic symptoms. The significance of early surgery and the method of clot removal will be discussed for ruptured aneurysms in the posterior fossa.
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