[Spontanious subarachnoidal hemorrhage: report on 67 surgicaly treated patients].

PURPOSE The aneurysmal subarachnoid hemorrhage (SAH) is a syndrom with an extremely complex pathophysiological course. Although treatment outcomes in patients with intracranial aneurysms of the circle of Willis and SAH have improved over time, the mortality and morbidity rates remain unacceptably high. The clinical course and the outcome were evaluated in a group of patients who underwent surgery. METHODS Patient characteristics, including age, sex, preexisting medical conditions, aneurysm location and size, time to admission, admission neurological status, computerized tomography and angiography findings were analyzed to determine relationship to outcome. A total of 67 patients with the intracranial aneurysms were treated by the microsurgical technique for a direct aneurysm surgery. The data were analyzed in two aspects: the overall management and the surgical results. RESULTS An occlusion of aneurysm neck was done in 97% and 3% of patients were treated by aneurysm wrapping. There was a significant relationship between the neurological status on admission and the outcome (p < 0.005). Out of 67 patients, 50% had a good result, 16% were moderately disabled, 18% were severely disabled, and 12% were dead at the six month post-SAH evaluation. The results were significantly better according to the better neurological status on admission (p = 0.0001). CONCLUSION The disastrous natural history of subarachnoid hemorrhage secondary to ruptured intracranial aneurysm has largely remained unaffected by even the best medical and surgical care because of the natural history of the disease, as well as mistakes in diagnosis and delays in treatment. Among the patients who were underwent surgery, 50% returned to their premorbid state, and 12% died. The factors associated with poor results were direct effects of the initial hemorrhage, vasospasm and rebleeding. Although the results of management of patients with ruptured aneurysms seem to be improved with time, there is opportunity for substantial additional improvement.