The International Cooperative Study on the Timing of Aneurysm Surgery

Part 2: Surgical results

Neal F. Kassell Department of Neurological Surgery, University of Virginia Health Sciences Center, Charlottesville, Virginia, and Department of Neurology, University of Iowa, Iowa City, Iowa

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 M.D.
,
James C. Torner Department of Neurological Surgery, University of Virginia Health Sciences Center, Charlottesville, Virginia, and Department of Neurology, University of Iowa, Iowa City, Iowa

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 Ph.D.
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John A. Jane Department of Neurological Surgery, University of Virginia Health Sciences Center, Charlottesville, Virginia, and Department of Neurology, University of Iowa, Iowa City, Iowa

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 M.D., Ph.D.
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E. Clarke Haley Jr. Department of Neurological Surgery, University of Virginia Health Sciences Center, Charlottesville, Virginia, and Department of Neurology, University of Iowa, Iowa City, Iowa

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 M.D.
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Harold P. Adams Department of Neurological Surgery, University of Virginia Health Sciences Center, Charlottesville, Virginia, and Department of Neurology, University of Iowa, Iowa City, Iowa

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 M.D.
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participants Department of Neurological Surgery, University of Virginia Health Sciences Center, Charlottesville, Virginia, and Department of Neurology, University of Iowa, Iowa City, Iowa

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Page Range:
37–47
Volume/Issue:
Volume 73: Issue 1
DOI link:
https://doi.org/10.3171/jns.1990.73.1.0037
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✓ A prospective, observational clinical trial was conducted by the International Cooperative Study on the Timing of Aneurysm Surgery to determine the best time in relation to the hemorrhage for surgical treatment of ruptured intracranial aneurysms. Sixty-eight centers contributed 3521 patients in a 2½-year period beginning in December, 1980. Analysis by a prespecified “planned” surgery interval demonstrated that there was no difference in early (0 to 3 days after the bleed) or late surgery (11 to 14 days). Outcome was worse if surgery was performed in the 7 to 10-day post-bleed interval. Surgical results were better for patients operated on after 10 days. Patients alert on admission fared best; however, alert patients had a mortality rate of 10% to 12% when undergoing surgery prior to Day 11 compared with 3% to 5% when surgery was performed after Day 10. Patients drowsy on admission had a 21% to 25% mortality rate when operated on up to Day 11 and 7% to 10% with surgery thereafter. Overall, early surgery was neither more hazardous nor beneficial than delayed surgery. The postoperative risk following early surgery is equivalent to the risk of rebleeding and vasospasm in patients waiting for delayed surgery.

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Contributor Notes

Address reprint requests to: Neal F. Kassell, M.D., Department of Neurological Surgery, University of Virginia Health Sciences Center, Box 180, Charlottesville, Virginia 22908.
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