Seventy seven asymptomatic nonruptured aneurysms were detected and treated surgically in 77 patients during these 20 years; 87% were treated in the last 8 years. All aneurysms were found on the conventional cerebral angiograms. Angiography was performed because of a family history of SAH in 16 patients, having other types of cerebrovascular diseases in 11, suffering from intractable headache in 28 and having other central nervous system diseases, such as brain tumors, in 22. Neither mortality nor morbidity was experienced except for one patient whose hemiplegia was aggravated secondary to the cerebral infarction. Long term follow-up studies (maximum 20 years) were done and the survival ratio was evaluated by the KAPLAN-MAIYER method. In the surgically treated groups, the survival ratio was significantly higher in the nonruptured group than in the ruptured group.
It is concluded that the most aggressive and effective approach to the treatment of vasospasms is prophylactic clipping of the aneurysms.
