For the past 50 years the pterional craniotomy has been the standard approach for anterior circulation aneurysms. However, this is a major procedure. As the trend is towards minimally invasive surgery generally, we have been developing a minimally invasive approach for anterior circulation aneurysms - the supraorbital microcraniotomy. We present first 50 patients who underwent this operation after an aneurysmal subarchnoid haemorrhage. The data were collected prospectively between 2001 and 2004. A total of 60 aneurysms were clipped (10 patients had two aneurysms). Forty-one of fifty patients (82%) were good grade (WFNS I and II) and 9/50 (18%) were poor grade (WFNS III - V) at the time of surgery. Anterior communicating aneurysms were the commonest (37%), but aneurysms at all of the usual anterior circulation sites were included, apart from ophthalmic aneurysms, as none presented during this period, and pericallosal aneurysms, which were not appropriate for it. Five patients (10%) also had an intracerebral haematoma on presentation. The overall management mortality for this series was 3/50 (6%) with 82% achieving a favourable outcome on the Glasgow Outcome Scale (GOS). For those in good grade at surgery, the mortality was 1/41 (2.4%) with 87.7% achieving a favourable outcome on the GOS.

Objective: The mortality of re-bleeding is high and patients surviving are usually in poor clinical condition and have a worse outcome than patients with single bleed. We performed an update systemic review and Meta-analysis to determine the most common risk factors for re-bleeding in aneurysmal subarachnoid hemorrhage patients.