Indications and Timing of Surgery on Ruptured Intracranial Aneurysms

  • Ram P. Sengupta
Conference paper


Direct surgical obliteration of a ruptured intracranial aneurysm without the associated problem of subarachnoid hemorrhage (SAH) can be achieved with less than 2% mortality and 5% morbidity. This excellent progress, however, does not take into account two major aspects in the management of patients with SAH. First, a significant number of patients suffer secondary deterioration and never come to surgery. The outcome of these patients, when added to the surgical outcome, the management mortality, and morbidity, is still appalling. Second, and in my view more significantly, treatment of a patient with SAH over the last three decades has been identified with the control of the ruptured aneurysm, but treatment of the disease itself was largely ignored. This was primarily due to the fact that pathological changes associated with SAH were unrecognised and the method of identifying them with investigation, such as angiography, was itself harmful in a severely ill patient. With the introduction of the CT scan, Doppler ultra-sound, MRI and PET scan, it is now possible to assess the living pathology of SAH and specific treatment can be instituted. There is yet another challenge, not altogether at the control of the neurosurgeons, which awaits us for the future. As early as 1956, Walton [10] in Newcastle showed that one-third of these patients die from initial bleeding. This occurs even today. There is clear evidence from the study by Kassell and Drake [3] that two-thirds of these are due to ignored warning signs, misdiagnoses or late referral. An educational program illuminating the perils of SAH can aim to conquer the natural history of SAH from ruptured aneurysm.


Intracranial Aneurysm Early Surgery Aneurysm Surgery Aminocaproic Acid Angiographic Vasospasm 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Allen GS, Batty ER, Boone S, Chou S, Kelly D, Weir B (1982) Preliminary results of multicentral double-blind prospective study of Nimodipine in the prevention of delayed neurological deterioration from cerebral arterial spasm. Proceedings of the Congress of Neurological Surgery, Toronto, p 98Google Scholar
  2. 2.
    Hori S, Suzuki J (1979) Early intracranial operations for ruptured aneurysms. Acta Neurochir 46:93–104PubMedCrossRefGoogle Scholar
  3. 3.
    Kassell NF, Drake CG (1983) Review of the management of saccular aneurysms. Neurol Clin (1): 73–86PubMedGoogle Scholar
  4. 4.
    Lindsay KW, Teasdale GM, Murray L, Knill-Jones R (1980) Observer variability in grading patients with subarachnoid haemorrhage. Proceedings of the Autumn Meeting of the Society of British Neurological Surgeons, pp 61-67Google Scholar
  5. 5.
    Norlen G, Barnum AS (1953) Surgical treatment of aneurysms of the anterior communicating artery. J Neurosurg 10:634–650PubMedCrossRefGoogle Scholar
  6. 6.
    Sano K, Saito I (1978) Timing and indication of surgery for ruptured intracranial aneurysm with regard to cerebral vasospasm. Acta Neurochir 41:49–60PubMedCrossRefGoogle Scholar
  7. 7.
    Sengupta RP (1975) Anatomical variations in the origin of the posterior cerebral artery demonstrated by carotid angiography and their significance in the direct surgical treatment of posterior communicating aneurysms. Neurochirurgia 18:32–42Google Scholar
  8. 8.
    Sengupta RP, So SC, Villarejo-Ortega FJ (1976) Use of epsilon aminocaproic acid (EACA) in the preoperative management of ruptured intracranial aneurysms. J Neurosurg 44:479–484PubMedCrossRefGoogle Scholar
  9. 9.
    Sengupta RP, McAllister VL (1986) Subarachnoid hemorrhage. Springer, Berlin, pp 193–196CrossRefGoogle Scholar
  10. 10.
    Walton JN (1956) Subarachnoid hemorrhage. Livingstone, EdinburghGoogle Scholar

Copyright information

© Springer Japan 1988

Authors and Affiliations

  • Ram P. Sengupta
    • 1
  1. 1.Newcastle General HospitalNewcastle upon TyneEngland

Personalised recommendations