Ruptured intracranial aneurysms: the preoperative management and the timing of surgery

The authors review 179 consecutive cases of ruptured intracranial aneurysms: 80 out of the first 101 patients underwent aneurysm surgery in a period ranging from 7 days to 2 weeks following subarachnoid haemorrhage (SAH) and patients with all grades of the Hunt and Hess classification were included without discrimination. The total case mortality rate was 23%. The postoperative mortality rate was 16%. Of the 78 patients in the 2nd group, 44 cases were operated upon. All patients with grades I, II and III and five cases with IV and V underwent aneurysm surgery. The timing of surgery was established on the basis of the various clinical and biochemical data, especially the improvement of meningeal signs, and decreased sensitivity of cerebral vessels to vasoconstriction. In this group the angiographic vasospasm and focal neurological deficits, without further clinical damage, were not considered a risk for surgery. The surgical mortality rate was 7%. The evidence presented indicates that both a more selective method of assessing the preoperative neurological function and also an appropriate timing of surgery have improved the surgical morbidity and mortality.