[The same question for the past 20 years: when should a ruptured intracranial aneurysm be surgically treated? (Experience with 434 cases)]

Abstract

The timing of surgery for the ruptured aneurysm (SAH) remains controversial. After the period of delayed surgery, the early surgery is now more and more frequently advocated. This paper, study our experience in aneurysm surgery in two different periods, considering only patients admitted in grades I to IV, excluding grade V patients (deep coma, decerebration). During the former period (1972-1984) 328 patients were admitted and considered for delayed surgery, usually during the second week following SAH. 94.5% of patients were operated upon. 5.5% patients died before surgery, from ischemia (3%) or from rebleeding (2.5%). 38.5% were admitted between (D.O-D3) after SAH, D.O being the day of SAH. Only 5.7% were operated upon between D.O-D3. The higher peak of surgery was during the second week (41.8%) and during the third week (39.2%). During the later period (1985-1988) 106 patients were admitted, 50% of them between D.O and D3 after SAH. Every patient was operated upon. The patients admitted between D.O and D3 were operated upon as follows: between D.O and D3 = 32.1%, between D4 and D6 = 22.6%, between D7 and D15 = 34%, after D16 = 11.3%. The analysis of these sub-groups demonstrates that the distribution was related to the age and clinical status. Patients being awake and under 50 years of age were considered for early surgery. Patients being obnubilated or stuporous, and over 50 years of age were planned for delayed surgery. Angiographic spasm and extension of blood in CT Scan were taken in consideration to a lesser degree.(ABSTRACT TRUNCATED AT 250 WORDS)