[Deferred surgery of cerebral aneurysms. Long-term follow-up in 103 cases]

Between January 1981 and December 1985, 120 consecutive SAH patients were admitted. 73% were in satisfactory conditions and 27% in poor ones. All the patients underwent treatment with antifibrinolytics. Angiographic examination was performed 10 days after the last hemorrhagic event, while the patient's general and neurologic conditions were stable. The reparative operation was carried out immediately after. During the waiting phase there were 16 relapses, (15.5%), resulting in death in 11 (10.7%), and 13 cases of symptomatic vasospasm (12.6%), resulting in death in 5 (4.9%). Overall mortality was 20.4%, with a 17.5% preoperative mortality. On 89 operations carried out on 85 patients, the intraoperative mortality was 3.5%, and neurologic morbidity (transitory in all cases) was 3.5%. All patients underwent intra- or post-operatory angiography to prove the complete exclusion of the aneurysms. After an average follow-up of 36 months, on a total of 103 aneurysm SAH cases, there were 18 preoperative deaths and 3 surgical deaths (within 30 days from the operation); one patient died of unrelated causes during the follow-up period. Seventy-three patients (72.9%) were fully recovered (51.5% returned to their previous job and 21.4% obtained lesser employment). 5.8% of the patients had a varying degree of invalidity. The results of this series were satisfactory both for the low surgical mortality and morbidity rates and for the high percentage of total recoveries. Nevertheless the prevalence of fatal relapses still leaves room for alternate medical and/or surgical treatments.