✓ A nonsurgical treatment consisting of osmotherapy with 20% Mannitol was performed on a consecutive series of 23 male patients with chronic subdural hematoma, ranging from 21 to 71 years in age, including seven serious cases. Disappearance or marked reduction of the hematoma content and complete clinical recovery were obtained in 22 patients. The duration of the treatment was 12 to 106 days. Follow-up study from 8 months to 3½ years showed no sequelae, recurrence, or complications.
Jiro Suzuki and Akira Takaku
Akira Takaku and Jiro Suzuki
Origin, rupture, repair, and growth
Jiro Suzuki and Hiro Ohara
✓ The origin and mechanism of rupture, repair, and growth of intracranial saccular aneurysms are reported in an investigation of 45 aneurysms (23 unruptured and 22 ruptured) found in 34 brain specimens. Gaps in the media at the bifurcations of cerebral arteries are important for aneurysmal formation. The walls of aneurysms smaller than 3 mm in diameter are mainly composed of endothelial cells, and fibrous tissue. When aneurysms grow larger than 4 mm, the walls become collagenous and extremely thin portions develop in their domes, forming potential rupture points. Immediately after the rupture, bleeding is stopped by clot and a new fibrin layer is formed around the rupture point. It is proposed that the cerebrospinal fluid has a special accelerating action in clot formation. This fibrin layer is weak, and repeat rupture occurs within 3 weeks after the initial hemorrhage. However, after 3 weeks, rebleeding is rare due to the reinforcement of this layer, and capillaries appear in this new wall. Hemorrhages from these capillaries occur within and outside the new wall caused by the constant impingement of blood flow. In severe cases, the aneurysm ruptures again, but when the hemorrhages are slight, the aneurysm grows as the wall is thickened by repeated hemorrhages and their absorption. This may explain the growth mechanism of the aneurysm.
Takashi Yoshimoto and Jiro Suzuki
✓The authors document angiographically the development of a large aneurysm from the funnel-shaped bulge at the origin of the left posterior communicating artery.
So Sato and Jiro Suzuki
✓ The authors used light and electron microscope to examine the capsules of chronic subdural hematoma in 33 cases. In cases with neurological deficits, capillary endothelial cells in the capsule had many cytoplasmic protrusions and fenestrations, suggesting high permeability of the capillary wall. Endothelial degeneration was also observed in these cases. These morphological changes were reversed by osmotherapy. Formation of collagen fibrils from fibroblasts in the hematoma capsule was frequently observed in the cases treated by osmotherapy.
Jiro Suzuki and Takehide Onuma
✓ Nine cases of intracranial aneurysm associated with cerebral arteriovenous malformation (AVM) were found in a total of 140 patients with cerebral AVM (6.4%). Radical operation was performed for both angioma and aneurysm in eight cases and for aneurysm only in one case. The suitability of surgical treatment of both aneurysm and angioma is discussed.
Experience in a Series of 19 Cases
Jiro Suzuki and Takashi Iwabuchi
Shigeaki Hori and Jiro Suzuki
✓ During the 14-year period up to September, 1975, 346 patients with a single anterior communicating artery aneurysm, including eight with unruptured aneurysms, were operated on by direct intracranial procedures. There was an early operative mortality of 5.5%. Follow-up studies, an average of 3 years 11 months after surgery, revealed that about 85% of the survivors, excluding those who could not be followed, had regained their working capacity, and that the late mortality and morbidity rates were 9.6% and 2.0%, respectively. The rationale for performing the intracranial operation and factors influencing postoperative results are discussed, with particular emphasis on the techniques for accurate treatment of aneurysms that help to prevent postoperative rebleeding and therefore give better overall surgical results.
Jiro Suzuki and Shigeaki Hori
Takehide Onuma and Jiro Suzuki
✓ The authors report the cases of 32 patients with aneurysms measuring 2.5 cm or greater in diameter found among 1080 patients with saccular cerebral aneurysms. Of the 32 patients, 24 patients were treated by direct operation, four by common carotid ligation, and the other four by conservative therapy. The appropriateness of surgery and surgical method are discussed.