[Acute subarachnoid hemorrhage after aneurysm rupture: results of early surgery]

The introduction of early aneurysm surgery in subarachnoid hemorrhage in the beginning of the eighties diminished the frequency of rebleeding. However, there are some objectives against early surgery due to its supposed higher morbidity. The present retrospective data elucidates the advantage of early aneurysmal surgery. In 1990 and 1991 we treated 175 patients with subarachnoid hemorrhage, of which 9 had no vascular malformation. In 166 patients a total of 190 aneurysmal malformations could be found. Of 60 patients with preoperative good clinical grades I and II (according to Hunt and Hess) 59 patients (99%) showed good or very good results classified by the Glasgow Outcome scale (GOS). Only one patient did not survive. Even in 61% of patients with poor grade aneurysms (III to V by Hunt and Hess) the outcome was good to very good; 15 patients (14%) survived with a distinct neurological deficit (grade 3 by GOS). Only one patient remained in a vegetative state. The total mortality of these 106 patients with grades III to V (Hunt and Hess) was 24%, among them 15 patients with preoperative grade V (Hunt and Hess). Overall it can be established, that there are no definite disadvantages of early aneurysmal surgery. The benefits of early surgery are a minimized risk of rebleeding, some effects of ameliorated conditions for intensive care treatment still have to be proven. Not only patients in good clinical condition (I and II by Hunt and Hess) show a good prognosis, even for patients with poor grade aneurysms (III to V by Hunt and Hess) a very good or at least good result can be achieved in 61%.