The results of the surgery of ruptured aneurysms in different series over the years have been published elsewhere (Gillingham, 1958, 1967, 1975; Gillingham et al., 1976) and have been interpreted in the light of the evolution of management. As has been pointed out by Hunt and Hess (1968), it is not enough to publish the results of operative treatment only in relation to grading of the patient’s condition after aneurysmal rupture. It must also be made clear whether the grading relates to the condition on admission or on the day of operation (Gillingham, 1975). Further, the day of operation related to the time of the subarachnoid haemorrhage has to be stated and whether it is the first haemorrhage, the second or later and also whether antifibrinolysins have been used and if so then the day of commencement and the dosage. Finally, it must be made clear in any operation series what has happened to the nonoperated patients. However, this obviously can only relate to those patients referred to and seen by the neurosurgeon concerned. There are obviously some in any community, particularly in which the family practitioner is less enlightened, which are not referred. Also from time to time for capricious reasons, some patients will not be referred early, even though the family doctor is astute and interested in early diagnosis and referral. So there will inevitably remain gaps leaving some doubt about the statistical validity in any series. However, in a closed community such as South-eastern Scotland where the standard of family practice is high, most patients would seem to be referred after the first subarachnoid haemorrhage, approximately 60% of which are of the pattern of the “minor leak” (grade I on admission, Gillingham, 1958).
KeywordsToxicity Meningitis Mannitol Hunt Meningioma
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