The principle role of treatment for ruptured aneurysm has been to obliterate the aneurysmal sac and secure the patient's life from the hazards of rebleeding and vasospasm. The timing of surgery is still the focus of neurosurgical controversy.
Recently
there has been a resurgenece of interest in the early operation and increasing number of surgeon have been adopting this modality.
The clinical material for this study consists of 1409 consecutive patients with ruptured aneurysm admitted to the Pusan Paik's hospital, School of Medicine, Inje University from January 1980 to June 1993.
Operations were performed in 1000 cases and 409 cases were not operated due to refusal of operation. moribund discharge after rebleeding and vasospasm, and medical problems, etc.
In 1000 operative group, 383 cases were anterior communicating artery aneurysms, 304 internal canotid artery aneurysms, 256 middle cerebral artery aneurysms, 24 anterior cerebral artery aneurysms and 33 cases were verebrobasilar artery aneurysm.
The operative cases were devided into 3 categories; the first is 456 operative case in which the direct operation carried out within 3 days after last subarachnoid hemorrhage, and 86% had a favorable outcome, 7% died, the second is the 301
operative
cases between 4 days and 10 days after last subarachnoid hemorrhage, 80% had favorable outcome, 10% died, and the last is 243 late operative cases performed greater than 10 days after subarachnoid hemorrhage, 84% had favorable outcome, 9% died.
Overall
surgical result was favorable outcome in 84% and 8% mortality, Most of the mortality and morbidity is related to initial insult of bleeding, rebleeding, vasospasm, surgical complications, and medical problems In this study, the surgical timing
and
problems during operation for ruptured intracranial aneurysm are discussed.
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