Ruptured Aneurysms within 24 Hours after Subarachnoid Hemorrhage Surgical Results of 69 Cases

Timing of operative treatment of SAH in the acute stage is still controversial. Since September 1976, 291 cases of aneurysm were operated. Two hundred twenty-three cases out of 291 were operated by the same neurosurgeon. Of the 223 cases, 69 cases for which surgery was performed in the acute stage, within 24 hours after SAH, were analysed. There were 2 fatal cases in the acute stage surgery in the neurological Grades II and III; the remaining 30 cases in Grades II and III recovered. In 22 Grade IV cases, 6 were fatal. In Grade V there were 19 fatal cases out of 23; only one case recovered well. The mortalities in acute stage surgeries were 39% including Grade V and 6.7% when confined to Grades II and III. On the contrary, mortalities in late surgery were 2.4%. Cases of chronic stage surgeries (operated after two weeks) were mainly of Grades I and II. Of the 48 cases which were treated conservatively, 40 cases were fatal. Therefore the overall mortality of delayed cases was 26.6%. Vasospasms occurred in over 40% of cases of subacute stage surgeries (operated from 2 to 14 days). However, in acute stage surgeries (within 24 hours) vasospasms occurred only in 10.6%. In chronic stage surgeries, vasospasms occurred in 8.1% of cases which were waiting for surgery. Symptomatic vasospasms occurred more often (18.2%) in delayed cases (over 24 hours) than in acute stage surgery cases (10,9%). Frequency of vasospasms was high in cases in which CT revealed packed hematoma in the basal cistern, even if the surgery was delayed until the chronic stage. However, vasospasms occurred less often in cases of acute stage surgery (within 24 hours after SAH). Therefore, acute stage surgery within 24 hours should be absolutely indicated in cases in which CT revealed packed hematoma in the basal cistern.