Early intracranial operations for ruptured aneurysms.

During the period between June 1961 and September 1975 320 patients with saccular aneurysms were operated on by intracranial procedures within 14 days of their last subarachnoid hemorrhages. Overall operative mortality rate for the 14 year period was 10.6%, being 18.9% for 143 cases operated on within 7 days of rupture and 4.0% for 177 cases operated on between the 8th and 14th days. The mortality was reduced to the zero level by 1975 in the groups operated on within 48 hours and 8 to 14 days by selection of the patients as well as by improvements in surgical techniques and adjuncts, but did not reach a satisfactory level in the group operated on between the third and seventh days mainly because of fatality due to postoperative vasospasm. The quality of survival after surgery performed within seven days was better than that of surgery performed at eight days or later. Based on these results, the rationale for and technical problems concerning the early stage operations are discussed.