Results of treatment for cerebral saccular aneurysms in a small neurosurgical unit--evaluation of early operation and nimodipine treatment.

91 patients in Hunt and Hess grade I to III directly after aneurysm rupture in the anterior circulation were treated by earliest possible surgery in conjunction with parenteral Nimodipine. 96% of the cases were seen in this centre within 24 hours from bleeding and surgery was commenced in 78% within 48 hours post haemorrhage. 8% suffered from "ultra early" rebleds six of which proved fatal. 12% of the cases had medical and surgical complications whereas only 3% had permanent late ischaemic sequelae. This low incidence of ischaemia may suggest a beneficial effect from Nimodipine treatment. The need for an aggressive surgical approach to aneurysms in order to minimize the omnious impact of rebleedings is stressed, although the importance of complications and technical misadventures must also be taken into consideration.