Objectives: The timing of aneurysm surgery has been a topic of major neurosurgical controversy.
Aneurysmal rebleeding is the most cataclysmic and disabling event following initial subarachnoid hemorrhage. Thus, early surgical obliteration of aneurysm eliminates the potential for rebleeding during the highest risk period.
Methods: The results of operaton for the twenty-three patints who had admitted to neurosurgical departments, Mokdong hospital and undergone surgery within the 24-72 hours after initail rupture of these aneurysms form Octover, 1993- to August, 1996, were reviewed.
Resutts: Twenty-three patients underwent craniotomy for clipping and intracranial clot evacuation, and postoperative hypertensive, hypervolemci, and hemodilution therapy. The outcome was excellent in 10(43%), good in 3(13%), poor in 5(22%), and deaht in 5(22%). The mean age was 57.7 and the ratio of male to female was 13:10. Teh outcome according to Hunt-Hess(H-H) grade was follwings. H-H grade 1 was 2(%) and all excellent outcom, H-H grade 2 24(61%) and the outcomes were excellent in 8(35%), good in 1 (4%), poor in 2(9%), death in 3(13%). H-H grade 3 was 6(26%) and good in 2(9%), poor in 2(9%), death in 2(9%), and H-H grade 4 was 1(4%) and the outcomes poor in 1(4%). The outcome according to grading system of Fisher was followings. Grade 2 was 6(26%), and the outcome was excellent in 5(22%) and death in 1(4%). Teh grade 3 was 14(61%) and excellent in 5(22%), good in 2(9%), poor in 3(13%), and death in 1(4%). The grade 4 was 3(13%) and good in (4%) and poor in 2(9%). The variatins in anterior communicating complex were followings. The both A₁equal in 6(26%), left A₁dominancy was 1(4%), right A₁atersia was 13(57%) and left atresia was 3(13%).
Conclusions: The most favorable outcomes and lowest mortality rate were patients of H-H grade 1 group. Teh surgical results of alert patients with early surgery should even further improve as compared to delay surgery. However, patients who present in poor medical condition at the time of operation were still indicated delay surgery.
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