Emergency treatment of cerebral aneurysms with large haematomas.

Of 469 patients with subarachnoid haemorrhage (SAH) from ruptured intracranial aneurysms, 31 had large intracerebral haematomas and were treated as emergency cases at the University Central Hospital, Kuopio, Finland during 1979-1985. The haematomas were evacuated and the aneurysms clipped immediately after diagnosis with CT and angiography. The mean diameter of the haematomas was 48 mm. Of the 31 patients 15 died. Mortality was lower for patients with aneurysms of the middle cerebral artery and for those with a better clinical grade (Gr. IV) at the time of the operation (41%); all patients with dilated pupils in grade V died. Five patients returned to work, and 10 are living a useful and independent life at home. Because early CT is increasingly used as the first diagnostic tool in vascular catastrophies, the pressure for early emergency treatment of aneurysmal intracerebral haematoma is increasing. The almost 100% mortality with conservative treatment should be compared to the 41% mortality with selection of the surgical candidates.