title: Results of direct surgery for aneurysmal subarachnoid haemorrhage: outcome of 2055 patients who underwent direct aneurysm surgery and profile of ruptured intracranial aneurysms.
abstract: OBJECTIVE
  The purpose of this study is to evaluate the therapeutic value of our surgical treatment of subarachnoid haemorrhage in a large series with standardized surgical principles.
  
  
  METHODS
  Results of 2055 direct operations on ruptured intracranial aneurysms, treated in our institutions, where surgical indications, instruments and techniques were standardized, between 1988 and 1998, were retrospectively evaluated and outcome of the patients was discussed; cases treated by intravascular procedures were excluded.
  
  
  RESULTS
  According to the evaluation at discharge, 1083 (52.7%) patients were excellent, 324 (15.8%) good and 223 (10.9%) fair. There were 160 (7.8%) patients of poor outcome and the remaining 265 (12.9%) died. There were no differences in the outcome between pre-operative Hunt & Kosnik grade I and II, Fisher Scale 1 and 2, anterior circulation aneurysms and posterior circulation aneurysms except those at and around the basilar bifurcation, men and women, and those clipped and not clipped.
  
  
  CONCLUSIONS
  The factors related to poor outcomes were, age of 60 years or over, pre-operative Hunt & Kosnik grade II or more, Fisher Scale 3 or more, aneurysm size over 15 mm in diameter, and location at and around the basilar artery bifurcation. The results presented in this study show the status of our direct surgical management of subarachnoid haemorrhage in a large series with standardized surgical principles and procedures.
authors.affiliation: Division of Neurosurgery, National Nagano Hospital, Ueda, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Osawa
authors.forename: K
authors.initials: K
authors.lastname: Hongo
authors.forename: Y
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Y
authors.initials: Y
authors.lastname: Nakamura
authors.forename: K
authors.initials: K
authors.lastname: Kitazawa
authors.forename: S
authors.initials: S
authors.lastname: Kobayashi
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000601:surgery*; D002536:Cerebral Arteries / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D013345:Subarachnoid Hemorrhage / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods