Early operation for the ruptured intracranial aneurysm

It has been commonly accepted that the intracranial direct surgery, especially of aneurysmal neck occlusion, is the most desirable treatment for the intracranial aneurysm. However its timing is still controversial. In this report, early operation for the ruptured intracranial aneurysm was advocated based on the analysis of cases, encountered until the end of December, 1970, in which direct operation was performed within 3 weeks from the last subarachnoid hemorrhage, with special reference to the causes of death. The most reliable clinical parameter in deciding the timing of intracranial direct surgery seems to be the course of patient's consciousness. Age, blood pressure, site of aneurysm, motor disturbance, cranial nerve disorder and preoperative vasospasm were less related to the surgical results. The meningeal irritation and frequency of the past subarachnoid hemorrhage were related to the surgical results to some extent only. Therefore direct operation should be performed for the ruptured intracranial aneurysm even within one week after the last attack, providing the patient is neither in a state of coma nor in a down hill course of consciousness.