[Early versus delayed surgery for treatment of aneurysmal subarachnoid hemorrhage]

Notwithstanding large cooperative epidemiological studies, in depth pathophysiological studies on subarachnoid hemorrhage, a unique surgical strategy has not emerged on the timing of aneurysmal subarachnoid hemorrhage. We define as early surgery the one which is practiced in the first 72 hours after the hemorrhage, and delayed surgery the one which is practiced more than 72 hours after the bleeding. Early and delayed surgery have both advantages and disadvantages, but as shown in the "International Cooperative Study on the Timing of Aneurysm Surgery" there are no significant differences in term of mortality and morbidity between early and delayed surgery. In fact the postoperative risk following early surgery is equivalent to the risk of rebleeding and vasospasm in patients waiting for delayed surgery. The novelty in the surgical timing of patients harboring an aneurysm which has bleed, is on one hand the "Ultra early surgery" which is performed not longer than 24 hours after the bleeding and on the other hand the attempt to individualize the timing of surgery on each single patient.