Results of microsurgical management of ruptured intracranial aneurysms

The authors report the results of microsurgical management of 209 cases of ruptured intracranial aneurysms. The outcome of the surgery is discussed from the point of view of operative timing, preoperative grade, age and the effect of vasospasm. The operative results at the time of discharge were as follows: 137 excellent cases, 18 good, 31 fair, 8 poor and 15 deaths. The overall mortality rate was 7% and those patients designated as excellent and good who returned to work fully accounted for 74%. The result was achieved even though 65% of the patients were operated on within 2 weeks after the onset, and 44% of the patients were categorized as grade III, IV and V in Hunt's classification. In the morbidity and mortality, over half of the patients categorized as fair, poor and death were complicated by vasospasm, and the result was attributed mainly to the vasospasm. Therefore, we strongly believe that radical surgery is recommended to prevent rebleeding in the waiting period, there should be a greater understanding of "vasospasm" in order to improve overall morbidity and mortality.