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Delayed surgery for ruptured intracranial aneurysms: a reappraisal
R S Maurice-Williams1, J P Wadley
1Department of Neurosurgery, Royal Free Hospital, London, UK.
British Journal of Neurosurgery
|April 1, 1997
Summary
Delayed surgery for ruptured brain aneurysms did not significantly impact patient outcomes. While some patients might have benefited from earlier intervention, overall results suggest timing is less critical than previously thought.
Area of Science:
- Neurosurgery
- Neurology
- Vascular Surgery
Background:
- Delayed aneurysm surgery was once standard but is now uncommon.
- This study analyzes outcomes of a delayed surgery policy over 14 years.
Purpose of the Study:
- To analyze the outcome of delayed surgery for ruptured aneurysms.
- To evaluate the effect of surgical timing on patient management outcomes.
Main Methods:
- Analysis of 400 consecutive patients with ruptured aneurysms.
- Delayed surgery policy: generally 8-10 days or longer for unstable patients.
- Outcome assessment at 1 year using Glasgow Outcome Scale (GOS).
Main Results:
- 72% of patients underwent surgery, mostly after day 8.
- Overall, 68% achieved GOS Grade 1 (good recovery), 26% died.
- Operated patients had 88% GOS Grade 1 and 3.5% 30-day mortality.
Conclusions:
- Delayed surgery's effect on outcome is doubtful, aligning with Cooperative Study findings.
- Only a small number of deaths from rebleeding occurred in patients fit for earlier surgery.
- Non-hemorrhagic deterioration (NHD) was a significant factor, peaking within 10 days.