Aneurysm surgery during the acute phase

Abstract

Many different characteristics of aneurysm surgery in the acute phase of subarachnoid hemorrhage arise from the condition of the brain struck by the acute insult and possibly, suffering from adverse effects, such as swelling, edema, hydrocephalus, and disturbed autoregulation of cerebral blood flow. Several measures can be adopted to reduce the incidence of these events and to facilitate brain slackness. Cerebrospinal fluid drainage by ventriculostomy and opening the basal cisterns has a major role. Some technical details for parent vessels and neck exposure in acute surgery require special considerations, and these are described for the most common aneurysms. The question of the proper timing for aneurysm exclusion remains unanswered. We add to the literature our experience with 338 patients with acute subarachnoid hemorrhage mostly treated by early obliteration of the aneurysm (surgical clipping in most cases and coiling in a few cases).