Abstract
Six hundred and fifteen patients with aneurysmal subarachnoid hemorrhage, under the age of 70 years, who were consecutively adrmitted to Kagawa Prefectural Central Hospital from July 1972 to June 1994, were reviewed. The changes in treatment protocol durng this peroid included the institution of early surgery instead of delayed surgery and the development of a variety of modalities for the treatment of cerebral vasospasm. This resulted in an increased rate of patients who actually underwent direct aneurysmal clipping. The outcome evaluated at 6 months after the first hemorrhage was significantly improved during this period, especially in patients with Hunt and Kosnik grade III (p <0.05 x2). Patients classified as showing good recovery (Glasgow outcome scale) increased from 6.3% to 61.3%. Mortality decreased from 28.3% to 9.7%. Early surgery eliminated fatal rebleeding and vasospasm while awaiting scheduled surgery. Advanced operative procedures and perioperative management improved the outcome of patients who underwent surgery. The major problem with the current protocol is preoperative rebleeding at the acute stage, and further progress on this subject is considered mandatory.
