Prophylactic volume expansion therapy for the prevention of delayed cerebral ischemia after early aneurysm surgery. Results of a preliminary trial.

From June 1986 to June 1987, 47 consecutive patients with ruptured intracranial aneurysms were treated with immediate aneurysm surgery and prophylactic volume expansion therapy for ten to 14 days after subarachnoid hemorrhage (SAH). Twenty-four patients were admitted within three days of SAH. Twenty-three of these patients had an excellent result, and one patient died. There were no cases of delayed cerebral infarction. In 18 of 23 patients admitted more than three days after SAH, there was an excellent result. The other five patients had permanent morbidity related to the original SAH. These preliminary data suggest that immediate aneurysm surgery and aggressive postoperative prophylactic volume expansion in all patients can substantially reduce rebleeding and delayed cerebral ischemia, potential causes of morbidity, after aneurysmal subarachnoid hemorrhage. A more extensive prospective trial of this approach will be required to test this hypothesis.