[Arguments for early intervention in intracranial aneurysms. From a series of 33 aneurysms with hematoma]

33 cases of intra-cerebral hematomas after rupture of intra-cranial aneurysm are reported: 12 were operated on emergency (before 24 hours); surgery was delayed in 13 cases, and 8 died before surgery. Mortality in operated cases is not as high as usually considered (28%). Results of patients with late surgery (day 3 to day 30) are similar to those patients with early surgery in spite of better neurological state. These poor results are related to worsening because of spasm development during time elapsed before surgery. Early surgery may prevent spasm development by release of blood clots out of basal cisterns. This attitude can be extended in cases with large amount of blood clots in subarachnoid spaces. Out of 23 cases with unoperated aneurysm, 8 cases had an hematoma and 6 died, and 11 cases had an important subarachnoid haemorrhage and 9 died. Except in one case, death was related to spasm development.