[Subarachnoid hemorrhage caused by rupture of intracranial saccular aneurysm. Epidemiology, natural history, treatment]

Abstract

The basic goal of surgical treatment of cerebral aneurysms is to prevent further bleeding and, if the malformation is large and compressed neighboring nervous structures, to free them from compression by the sac. Modern neurosurgical procedures can effectively achieve this aim. Proper application of surgery requires on accurate knowledge of the natural history of this disease that surgery is designed to treat. Only trough and understanding of both rebleeding rates and the natural history that the neurosurgeon can judge the proper timing of surgical intervention and assess the overall efficacy of his or her medical and surgical treatment. The therapeutic philosophy at our institution for years has been that the patients meeting the criteria of Botterel grade I and II are offered definitive intracranial surgery early in then posthemorrhagic period (first hours preferably or during the first 48-72 hours). More seriously ill patients are treated medically until their clinical condition seems stable and then subjected to surgical therapy. The only exception regard the patients in poor condition (grade III, IV and V) who reach the hospital quickly after hemorrhage (first hours). The patients undergo surgery at once. This timing, together with CT scanning, more aggressive medical and surgical treatment, and the operating microscope have lowered operative mortality and improved the quality of life.