PHILADELPHIA PSYCHIATRIC SOCIETY

Abstract

patients remained in a vegetative state. Falconer and Elvidge have reported cases with lasting mental disturbances similar to those following prefrontal lobotomy. I agree with most of Dr. Sugar's comments. The decision to attack an aneurysm intracranially is often difficult to make after the patient has satisfactorily recovered from cervical ligation of the carotid artery. No matter how challenging the intracranial approach may seem to a daring surgical technician, a responsible physician will hesitate to gamble recklessly with the patient's life. Disagreeing with Dr. Voris, I believe that the angiographie procedure may be carried out at any time, even during the phase of acute bleeding. There is no evidence that angiography may cause a new blow out. On the other hand, ligation may have to be delayed because its risk is much higher during the phase of bleeding. This is particularly true in the case of the intracranial ligation. Craniotomy, therefore, should be postponed until the signs of subarachnoid hemorrhage have abated. TheTower surgical mortality rate during the quiescent phase probably outweighs the potential risk of further hemorrhage during the period of waiting.