Acute surgery in intracranial aneurysms. Experience with 100 cases.

In the last 3.5 years (up to August 1988) out of 450 patients with surgically treated intracranial aneurysms in 100 cases (22%) acute surgery was performed (up to 72 h after SAH). Patients in grade I-III (WFNS scale) were operated upon. In all the cases there were supratentorial aneurysms. CSF drainage during the operation was used routinely and nimodipine topically, in intravenous infusion and orally was applied. In all the cases, but one, the aneurysms was clipped. Follow-up--1 year. Assessment of the results was done using the Glasgow Outcome Scale (GOS). Full recovery was obtained in 78 patients and further 5 patients are independent. There were 14 deaths, in 7 patients due to postoperative vasospasm. Symptomatic ischaemia developed in 25 patients, however, in 15 of them it was fully reversible, due to the possibility of aggressive antivasospastic treatment (hypervolaemia, induced arterial hypertension). The relatively worse results were obtained in patients with chronic arterial hypertension.