[Neurosurgical therapy of subarachnoid hemorrhage]

Annually, there are about 12,000 cases of aneurysmal subarachnoid hemorrhage (SAH) in the Federal Republic of Germany. The clinical signs are usually highly indicative and the definite diagnosis is usually made with a CT-scan. The high morbidity and mortality has led to the development of rather immediate definitive management strategies. Presently most aneurysms are proven by digital subtraction angiography but modern cross-sectional techniques approach a level of equal sensitivity. The major element of the treatment of aneurysmal SAH is the triple-h therapy with hemodilution, hypertension and hypervolemia. Prerequisite for this regimen is the early, definitive occlusion of the aneurysm. In most cases this will be accomplished by surgical clipping. As a complement, endovascular techniques are being developed and constantly refined. An early operation may be inappropriate in patients with poor Hunt and Hess grade or in whom a difficult anatomical situation is present. This limitation does not apply to the endovascular occlusion. The course of SAH is characterized by a high incidence of secondary ischemic complication due to vasospasm which met with intraoperative rinsing of the basal cisterns, lysis of the clot with intracisternal rTPA, application of calcium antagonists as either causative or antagonistic treatment. Despite significant advances, the morbidity and mortality of SAH remains high, leaving sufficient space for further improvements.