Supported by the Ministry of Health, Labour and Welfare, a guideline for the management of aneurismal subarachnoid hemorrhage (SAH) was prepared based on the procedures of evidence based medicine (EBM). To utilize this guideline effectively and correctly, the following precautions are suggested.
(1) The described "level of strength of recommendation" for each procedure is not identical to the"level of strength of evidence". (2) The procedures recommended in the guideline may not be always applicable to the individual patient. Because of significant variations in the intracranial pathophysiology of SAH or systemic condition of the patient, the feasible management may be determined not by the "guideline" but by "the physician in charge". (3) Due to same reason, it may not be appropriate to refer to the guideline in a lawsuit for medical malpractice. (4) The content of the guideline may be behind the current standard unless it is properly updated. (5) Strong evidence is not easy to accumulate in the field of surgery. In the management of SAH, we still have only a very few number of scientific evidence. It is recommended of SAH, we still have only a very few number of scientific evidence. It is recommended for each surgeon to review his own clinical results critically to improve his daily practice.
