Grading of cerebral aneurysms and the timing of operation

The problem of acute and early operation is discussed on the basis of 630 patients with cerebral aneurysms, out of whom 50 were operated in the first week and 45 in the second week after bleeding. The mortality and morbidity for operation in the first week was significantly higher (20 per cent and 24 per cent respectively) than for operations performed in the second week after bleeding (8 and 14 per cent respectively). No certain differences, as far as the results are concerned, were found between patients operated up to the third day after the bleeding and those operated between the third and seventh day. There was a distinct correlation between the results and the grade of risk. The patients with multiple bleeds were at higher risk than patients with only one bleed. The possibility that angiography and operation provoke vascular spasm which finally leads to severe morbidity and mortality seems to be higher during the first week after the bleed than at a later stage. The figures analysed are small but speak in favour of an early operation in the second week after the bleed. However, this means that a significant number of patients may die before the operation because of recurrent haemorrhage. A far-reaching critical evaluation of acute versus early operation is necessary, as regards feasibility, indications and contra-indications.