Timing of surgery for ruptured aneurysms--experience from 800 consecutive cases.

In the Department of Neurosurgery, University of Vienna, about 800 patients with intracranial aneurysms have been operated since 1958. The distribution of age, sex, and the localization of the aneurysms correspond roughly to the international statistics. From our experience it is apparent that the level of consciousness and responsiveness is the most important factor in deciding the choice and time of treatment on the one hand and the further fate of the patient on the other. The authors therefore use some modification of the five-grade system of Hunt and Hess to stress the importance of the level of consciousness and the neurological deficits. As far as timing of surgery is concerned, the earliest possible microsurgical treatment for patients in grades I and II seems the method of choice, primarily to avoid rebleeding. Patients with impaired and/or fluctuating consciousness, neurological deficits and rather severe signs of meningeal irritation were operated as soon as the clinical picture became stable or showed a tendency to improve. Grade V patients were operated only if a life-threatening space occupying intracerebral haematoma was encountered by means of a CT scan. Nevertheless the authors have tried to avoid any too rigid routine and to adjust their decisions on therapeutic measurements according to the needs of the individual patient.