Ruptured intracranial aneurysms: a 12-month prospective study

A prospective study was undertaken of all cases of ruptured intracranial aneurysms that presented to Monash Medical Centre's neurosurgical service over a 12-month period. Forty-seven patients had proved aneurysmal subarachnoid haemorrhages. The management mortality rate over all was 23.4%. Forty patients underwent definitive treatment by craniotomy and clipping of the aneurysm; the operative mortality rate was 12.5%. Excellent results were obtained in all 22 patients whose clinical grade was good on the day of surgery; half these patients underwent operation within 72 hours of the episode. Sixty per cent of all patients were discharged from hospital without any neurological deficit; virtually all the remaining patients' morbidity and mortality were attributable to aneurysmal rebleeding and cerebral vasospasm. Early surgery for aneurysms has been the trend in North America, Europe and Japan and the results that were obtained in this study support early surgery in patients with a good clinical grade; further experience is needed to establish the optimal timing of surgery in patients with a worse clinical grade.