ABSTRACT
Successful surgical or endovascular occlusion of a ruptured intracranial aneurysm
virtually eliminates the potential for a recurrent subarachnoid hemorrhage (SAH).
Although these procedures are commomly performed in the early period following aneurysmal
hemorrhage, the patient remains at risk for a potentially fatal rebleed until the
aneurysm is successfully obliterated. A variety of logistic delays invariably prevents
the immediate treatment of a ruptured aneurysm. Indeed, the greatest risk for recurrent
hemorrhage may be in the first 6-24 hr following the initial rupture, precisely the
time during which the patient is undergoing initial assessment.
During a period of 111/2 years, we treated over 1000 patients with a ruptured saccular
aneurysm. We have specifically analyzed 467 of these patients with a Hunt and Hess
grade of I-III who were scheduled for early surgical intervention. We examined the
use of antifibrinolytic therapy prior to early surgery in these patients. We will
discuss the rationale for this treatment and provide an update of our results with
antifibrinolysis. Also, we will review other strategies that may be beneficial to
patients in the early period following aneurysmal SAH. Neurosurgeons need to maintain
attention to this relatively brief but critical period between rupture of an aneurysm
and its successful occlusion.
KEYWORD
Aneurysm - rebleed - antifibrinolytic therapy
