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.
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References
Ballantine, H.T.: Ruptured aneurysms of the anterior communicating artery: a review of the fate of 34 patients not subject to surgical intervention. Presented at meeting of the society of neurological surgeons. Boston, Ma. May 5, 1961. (Cit. from: Pool, J.L.: Timing and techniques in the intracranial surgery of ruptured aneurysms of the anterior communicating artery). J. Neurosurg. 199, 378–388 (1962)
Drake, C. G.: Comment on: Hunt, W. E., Hess, R. M.: Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J. Neurosurg. 28, 14–20 (1968)
Fisher, C. M., Kistler, J. P., Davis, J. M.: Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurg. 6, 1–9 (1980)
Fodstad, H., Lilienquist, B., Schannong, M., Thulin, C.-A.: Tranexamic acid in the preoperative management of ruptured intracranial aneurysms. Sug. Neurol. 10, 9–15 (1978)
Giannotta, S.L., Kindt, G.W.: Total morbidity and mortality rates of patients with surgically treated intracranial aneurysms. Neurosurg. 4, 125–128 (1979)
Hori, S., Suziki, J.: Early and late results of intracranial direct surgery of anterior communicating artery aneurysms. J. Neurosurg. 50, 433–440 (1979)
Hudson, C.H., Raaf, J.: Timing of angiography and operation in patients with ruptured intracranial aneurysms. J. Neurosurg. 27, 37–41 (1968)
Hunt, W.E., Hess, R.M.: Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J. Neurosurg. 28, 14–20 (1968)
9. >International cooperative study on timing of aneurysm surgery. Grant Proposal 1979
Koenig, G.H., Marshall, W.H. Jr., Poole, G.J., Kramer, R.A.: Rupture of intracranial aneurysms during cerebral angiography: Report of ten cases and review of the literatur. Neurosurg. 5, 314–324 (1979)
Krayenbühl, H.A., Yasargil, M.G., Flarnrn, E.S., Tew, J.M. Jr.: Microsurgical treatment of intracranial saccular aneurysms. J. Neurosurg. 37, 678–686 (1972)
Logue, V.: Surgery in spontaneous subarachnoid hemorrhage. Operative treatment of aneurysms of the anterior cerebral and anterior communicating artery. Brit. Med. J. 473–479 (1956)
McKissock, W., Paine, K. W. E., Walsh, L. S.: An analysis of the results of treatment of ruptured intracranial aneurysms. J. Neurosurg. 17,762–776 (1960)
Pool, J.L.: Timing and techniques in the intracranial surgery of ruptured aneurysms of the anterior communicating artery. J. Neurosurg. 19, 378–388 (1962)
Samson, D.S., Hodosh, R.M., Reid, W.R., Beyer, C.W., Clark, W.K.: Risk of intracranial aneurysm surgery in the good grade patients: Early versus late operation. Neurosurg. 5, 422–426 (1979)
Sano, K., Saito, I.: Timing and indication of surgery for ruptured intracranial aneurysms with regard to cerebral vasospasm. Acta Neurochirurgica 41, 49–60 (1978)
17.Suzuki, J., Yoshimoto, T.: Early operation for the ruptured intracranial aneurysm. Jpn. J. Surg. 3, 149–156 (1973) (Cit. from Yoshimoto et al. J. Neurosurg. 50, 152–157 (1979))
Winn, H.R., Richardson, A.E., Jane, J.A.: Late morbidity and mortality in cerebral aneurysms: a ten-year follow-up of 364 conservatively treated patients with a single cerebral aneurysm. Trans. Am. Neurol. Assoc. 98, 148–150 (1973)
Yasargil, M.G., Fox, J. L.: The microsurgical approach to intracranial aneurysms. Surg. Neurol. 3, 7–14 (1975)
Yoshimoti, T., Uchida, K., Kaneko, U., Kayama, T., Suzuki, J.: An analysis of follow-up results of 1000 intracranial saccular aneurysms with definitive surgical treatment. J. Neurosurg 50 152–157 (1979)
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Mehdorn, H.M., Grote, W., Tenfelde, B. (1981). Timing of Aneurysm Surgery after Spontaneous Subarachnoid Hemorrhage. In: Schiefer, W., Klinger, M., Brock, M. (eds) Brain Abscess and Meningitis. Advances in Neurosurgery, vol 9. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-67943-8_39
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DOI: https://doi.org/10.1007/978-3-642-67943-8_39
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