The International Cooperative Study on the Timing of Aneurysm Surgery

Part 2: Surgical results

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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.

Article Information

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

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Distribution of patients according to interval between subarachnoid hemorrhage and surgery.

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    Percent of patients with tightness of the brain during surgical exposure correlated with the day of operation after subarachnoid hemorrhage.

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    Favorable outcome (good recovery), disabled, and mortality rates in patients with surgery on Days 0 to 3 who were preoperatively alert (left) and preoperatively drowsy (right).

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    Mortality rate by three age strata and interval between subarachnoid hemorrhage and operation.

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    Mortality rate by three age strata and planned interval to surgery.

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    Six-month mortality rate by planned surgery interval and when surgery was performed. None = planned but no surgery; same = same interval; earlier = earlier than planned; later = later than planned.

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