Timing of Aneurysm Surgery after Spontaneous Subarachnoid Hemorrhage

Abstract

Subarachnoid hemorrhage (SAH) usually occurs in otherwise healthy persons. The risk of death or disability from rebleeding is particularly great in the first 2 weeks following SAH (18), but continues to be a serious hazard after 3 weeks (2). Therefore early surgical treatment with the aim of obliterating the bleeding source seems logical. However, early experience in aneurysm surgery showed that operation on patients in poor neurological and clinical condition resulted in excessive mortality (HUNT and HESS, 1968) (8). Most neurosurgeons therefore prefer to delay surgery until the patient’s neurological and medical status are stable usually at an interval of 1–3 weeks after SAH. There have been a few recent encouraging reports on early aneurysm surgery (16, 20). Early surgery has several theoretical advantages over delayed surgery: Prevention of rebleeding; amelioration of vasospasm; prevention and treatment of ischemic complications; ease of operation — dissection of the aneurysm; prevention of medical complications. In order to compare the beneficial and detrimental effects of early or late surgery on the final outcome of patients, we analysed the clinical course of 154 patients who underwent a direct surgical approach to an intracranial aneurysm between January 1, 1976 and December 31, 1979.KeywordsIntracranial AneurysmCerebral VasospasmAnterior Cerebral ArteryGrade VersusAneurysm SurgeryThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.