Treatment of patients with intracranial arterial aneurysms in the haemorrhagic period.

Our research protocol was implemented in the treatment of 395 patients in the acute period following aneurysmal subarachnoid haemorrhage. Patients are classified as follows: Compensated (roughly Hunt and Hess I-II); Subcompensated (Hunt and Hess III); and Decompensated (Hunt and Hess IV-V). Only patients in the compensated state are deemed candidates for acute surgery. Patients presenting in the subcompensated or decompensated state undergo aggressive supportive treatment. Vasospasm is treated with balloon angioplasty as soon as the diagnosis is made; early interdiction of this process lowers the risk of neurologic deficit. A complex regimen of antifibrinolytic therapy is instituted; rebleeding rates have been reduced by 50% using a combination of heparin and aminocaproic acid. Ventriculostomy is performed in all decompensated patients. All intracranial haematomas with evidence of mass effect are immediately evacuated. Patients undergo craniotomy for aneurysm when their condition stabilizes in compensated state.