[Outcome of ruptured intracranial aneurysms treated in accordance with the principle of deferred surgery. 308 consecutive cases over an 11 year period]

Abstract

The diagnosis of the aneurysm rupture either was assessed at the time of admission, or was assessed after the admission into the surgical department. Most patients were admitted after the first 24 hours following the S.A.H. From the beginning the patients were separated in two groups: 1) The patients unsuitable for planned surgery (grade V--Botterrel, or general contra-indication, such as neoplasm), 2) The patients planned for surgery and called much less than operable patients much greater than (grade I to IV--Botterell, without extra neurological contra-indication). The general management attitude consisted of the delayed surgery according to the neurological status of the patients, and the risk of vaso spasm and ischemia. Thus, in most cases, the surgery was delayed after the 9th day, following S.A.H., and even after the 12th day for anterior communicating aneurysms. The following results were observed: 1) Unoperable patients: (15) The 12 patients in grade V at the time of admission died (with or without emergency surgery). The 3 patients with a general contra-indication have been lost of view. 2) 293 patients were considered for delayed surgery: 16 died before the day of surgery (5,5%). Out of these much less than operable and no operated patients much greater than, 10 died from cerebral ischemia (3,4% of operable patients) and 6 died from hemorrhage recurrence (2%).(ABSTRACT TRUNCATED AT 250 WORDS)