Surgical treatment of aneurysmal subarachnoid haemorrhage in the presence of 24-h endovascular availability: management and results.

Endovascular treatment of ruptured intracranial aneurysms increasingly supersedes surgical repair. This study focuses on the management and results in 109 individuals treated surgically when both treatment modalities were available. The management principles were immediate identification of the origin of haemorrhage, early aneurysm repair, minimal brain retraction during surgery and rigorous prevention of secondary brain damage. Predominantly, aneurysms located on the middle cerebral artery and those of the posterior communicating artery were allocated to surgery. Despite of ultra-swift care, aneurysm rebleeds remained a challenge. Although one-third of the patients presented in a poor clinical grade, outcome was good with 87 (80%) of the individuals being independent, 16 (15%) being dependent and six patients (6%) dying. Results of surgical aneurysm repair are good presupposed the untiring ongoing efforts of an inter-disciplinary team of dedicated physicians and nurses.