Acute Surgical Treatment of Supratentorial Aneurysms

A consecutive series of fifty-six patients with ruptured aneurysms were operated upon within 24 to 72 hours after subarachnoid hemorrhage (SAH). All operations were performed by the author.

The clinical grading (Hunt and Hess) was I to II in 21, III in 11 and IV to V in 24. In 24 patient the internal carotid complex and in 18 it arose from the middle cerebral artery. The SAH as determined by computerized tomography was minor in 14, moderate in 5 and severe in 24. 15 patients habored intracranial hematomas (subdural, intracerebral or intraventricular hematoma). Of the patients preoperatively grade I or II, 86% had good neurological recovery, of the grade III patients good neurological recovery and of grade IV-V 75% had died. The mortality of the grade I-II patients operated upon within 24 hours, 24~48 hour and 72 hours were 11.1%, nil and 13.3% respectively. These results suggest that acute surgical repair of the ruptured cerebral aneurysms within 3 day of the ruptures in the grade I to III, is useful in preventing recurrence of hemorrhage and vasospasm through the removal of the subarachnoid clot.