Timing of operation for ruptured supratentorial aneurysms: a prospective randomized study

Area of Science:

• Neurosurgery
• Neurology
• Clinical Trials

Background:

• Aneurysmal subarachnoid hemorrhage (SAH) poses significant risks, with surgical timing and pharmacological interventions being critical management factors.
• Optimal timing for surgical intervention after SAH remains a subject of investigation to improve patient outcomes.

Purpose of the Study:

• To investigate the impact of surgical timing (acute, intermediate, late) on outcomes following ruptured anterior circle of Willis aneurysms.
• To evaluate the efficacy of nimodipine in preventing delayed ischemic deterioration in patients with SAH.

Main Methods:

• Prospective randomized study involving 216 patients with ruptured anterior circle of Willis aneurysms, stratified by Hunt and Hess Grades I-III.
• Patients were randomized into acute (0-3 days), intermediate (4-7 days), or late (≥8 days) surgery groups.
• A subset of patients participated in a double-blind placebo-controlled trial of nimodipine.

Main Results:

• Acute surgery (AS) was associated with higher independence rates (91.5%) at 3 months compared to intermediate (IS: 78.6%) and late surgery (LS: 80.0%).
• Management mortality was lower in the AS group (5.6%) versus the LS group (12.9%).
• Nimodipine significantly reduced delayed ischemic deterioration (p=0.01 overall, p=0.03 for LS).

Conclusions:

• Early surgical intervention for ruptured anterior circle of Willis aneurysms is associated with improved functional outcomes and reduced mortality.
• Nimodipine administration is effective in mitigating the risk of delayed ischemic deterioration after SAH.