+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Timing of operation for ruptured supratentorial aneurysms: a prospective randomized study



Timing of operation for ruptured supratentorial aneurysms: a prospective randomized study



Journal of Neurosurgery 70(1): 55-60



A total of 216 patients with a ruptured aneurysm of the anterior part of the circle of Willis were enrolled into this prospective randomized study of timing of the operation after aneurysmal subarachnoid hemorrhage (SAH). Only patients in clinical Grades I to III (according to the classification of Hunt and Hess) who were admitted and randomly assigned to a treatment group within 72 hours after the SAH were included in the trial. The patients were randomly assigned to one of three operation groups: acute surgery (AS: 0 to 3 days after the SAH; day of SAH = Day 0), intermediate surgery (IS: 4 to 7 days after the SAH), or late surgery (LS: 8 days to an indefinite time after the SAH). Three patients (4.3%) in the IS group and six patients (8.6%) in the LS group died before surgery was undertaken. At 3 months post-SAH, 65 patients (91.5%) from the AS group were classified as independent compared to 55 (78.6%) from the IS group and 56 (80.0%) from the LS group. The management mortality rate in the AS group was 5.6% compared to 12.9% in the LS group. Of the 216 patients enrolled in the timing study, 159 were randomly assigned to an independent double-blind placebo-controlled trial of nimodipine in Grade I to III patients. A total of 79 patients received nimodipine and 80 placebo. When the nimodipine group and the no-nimodipine group (the 80 placebo-treated patients plus the 52 patients who were not entered into the nimodipine trial) were analyzed separately, a significant difference was seen in the outcome of the no-nimodipine group (dependent AS vs. dependent IS, p = 0.01). Nimodipine treatment was associated with a significant reduction of delayed ischemic deterioration (all operation group combined, nimodipine vs. no nimodipine p = 0.01; LS with nimodipine vs. LS with no nimodipine, p = 0.03).

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 041812621

Download citation: RISBibTeXText

PMID: 2909689

DOI: 10.3171/jns.1989.70.1.0055


Related references

Rate and causes of mortality related to the timing of open surgery in ruptured supratentorial aneurysms series of 143 cases operated by 5 neurosurgeons. Auer, L M (Ed ) Timing Of Aneurysm Surgery Xiv+685p Walter De Gruyter And Co : Berlin, West Germany; New York, New York, Usa Illus 217-226, 1985

Timing of angiography and operation in patients with ruptured intracranial aneurysms. Journal of Neurosurgery 29(1): 37-41, 1968

Timing and indications for surgery for ruptured cerebral aneurysms-delayed operation. Nihon Rinsho. Japanese Journal of Clinical Medicine 36(3): 475-482, 1978

Ruptured intracranial aneurysms: acute endovascular treatment with electrolytically detachable coils--a prospective randomized study. Radiology 211(2): 325-336, 1999

Outcomes of early endovascular versus surgical treatment of ruptured cerebral aneurysms. A prospective randomized study. Stroke 31(10): 2369-2377, 2000

The timing of surgical treatment for ruptured intracranial aneurysms--from the viewpoint of intentionally delayed operation. Neurologia Medico-Chirurgica 21(8): 819-828, 1981

Timing of intracranial direct operation in ruptured cerebral aneurysms especially from analysis of rebleeding during the period of preoperative management. Neurologia Medico-Chirurgica 16(2 Pt 2): 127-136, 1976

Ruptured supratentorial arteriovenous malformations associated with venous aneurysms. Acta Neurochirurgica 128(1-4): 150-162, 1994

Timing of surgery for supratentorial aneurysmal subarachnoid haemorrhage: report of a prospective study. Journal of Neurology, Neurosurgery, and Psychiatry 72(4): 480-484, 2002

Factors predicting retreatment and residual aneurysms at 1 year after endovascular coiling for ruptured cerebral aneurysms Prospective Registry of Subarachnoid Aneurysms Treatment PRESAT in Japan. 2011

Factors predicting retreatment and residual aneurysms at 1 year after endovascular coiling for ruptured cerebral aneurysms: Prospective Registry of Subarachnoid Aneurysms Treatment (PRESAT) in Japan. Neuroradiology 54(6): 597-606, 2012

Results of delayed operations for ruptured supratentorial aneurysms in 22 consecutive patients. Journal of the Medical Association of Thailand 75(9): 495-501, 1992

Results of early versus delayed surgery for ruptured supratentorial aneurysms. Canadian Journal of Neurological Sciences 15(2): 183, 1988

Role of cerebral ischemia in the fatal development of ruptured supratentorial aneurysms. Neuro-Chirurgie 15(5): 353-368, 1969

Early operation for ruptured intracranial aneurysms: comparative study with computed tomography. Neurosurgery 12(2): 169-174, 1983