Surgery for Bleeding Aneurysms Historical Review and Personal Experience

The comparison between the overall results in series treated with late surgery and those obtained with early surgery demonstrates a marked reduction of mortality and an increase in good results in the series treated with early surgery. In many series in which a protocol of late surgery was employed no less than 10–15% percent of the patients died waiting for the operation.The advantage of early surgery is much more evident if the results are analysed on the basis of the Hunt-Hess grade on admission. In the past, some of the surgeons who considered early surgery an useful weapon for patients in Hunt-Hess I-II, thought that early surgery was too risky in Hunt-Hess III, and that grade IV and V patients should not undergo surgery.In Hunt-Hess III operative mortality and morbidity were respectively 15–30% and 10–25% with delayed surgery, but the overall mortality is up to 40% mainly due to the rebleeding rate. Operative result and overall outcome in Hunt-Hess III is much better in series treated in early surge...