[Surgical treatment of comatose patients after aneurysmal subarachnoid hemorrhage].

The author presents a series of 40 patients in coma after aneurysmal SAH treated between 1984 and 1994. The level of consciousness of those patients ranged between 3 and 9 points, graded according Glasgow Coma Scale. Eighteen patients were admitted within 72 hours after initial bleeding, five between 4-7 days after hemorrhage and in seventeen coma occurred due to rebleeding. Computerized tomography revealed only subarachnoid bleeding in 7 patients; eleven patients had massive intraventricular bleeding with consecutive enlargement of ventricles in 5. In 22 patients, subarachnoid hemorrhage with large intracerebral hematoma was found. In 5 patients with haematocephalus and in 4 with intraventricular bleeding, ventricular drainage was performed after admission. Post-drainage improvement of the comatose state occurred in 3 patients only and aneurysm was clipped later; two of them were cured and one died due to infectious complication. Six patients with intraventricular bleeding remained unchanged despite drainage and died in the early period after operation. Nineteen patients with intracerebral haematoma were operated on. In 10 of them surgery was limited to evacuation of the haematoma only and in 9 removing of haematoma and clipping of aneurysm were performed. Thirteen, operated on patients with intracerebral haematoma died and six survived. Twelve patients were not operated on. All of them died, most often due to rebleeding. Among 28 patients admitted in coma after aneurysmal haemorrhage and who were operated on as "the last chance for the patient" 20 died and 8 (28.6%) survived; 3 of them recovered completely or nearly completely, 4 were severed disabled and one remained in vegetative state.