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For some time we have been interested in the use of antifibrinolytic substances in neurosurgery. In 1967 we described the use of epsilon -aminocaproic acid (EACA) in two cases of arteriovenous malformations operated on in 1965 and considered it to be of definite value during the surgical procedures. In 1965 Mullan, reporting on some cases of intracranial saccular aneurysms, described the value of EACA in prolonging the duration of thrombosis in an electrically thrombosed aneurysm. In April 1967 at the European Neurosurgical Congress in Madrid we reported our principles for using EACA in the management of ruptured saccular aneurysms.It is well known that immediately after rupture a clot forms at the site of rupture in the aneurysm wall. This can be very well observed in operations in the acute stage. Early recurrent bleedings, which we all know have a very high mortality rate, usually take place around the second week after the initial bleeding. These are probably due to dissolution of the clot or changes in haemodynamic factors which cause the clot to give way. It is also a well-known fact that complicating vasospasm might occur in connection with early operations and the operative procedure can not be excluded as a factor contributing to this. If the risk of early recurrent bleeding could be eliminated or diminished by giving EACA the operative procedure could be postponed to a later time when the operative risk is considerably less.These considerations do not alter our opinion that in certain circumstances very early surgery may be indicated even on the same day as the initial bleeding. Angiography has to be performed as early as possible in these cases and before EACA has been given.14 cases of ruptured aneurysm at different locations have been given antifibrinolytic substance and all have been operated upon. Three patients were treated with EACA, 4-5 g 4 times daily and 11 cases received Cyklokapron, 10 mgm per kilo body weight 3-4 times daily intravenously. 11 cases were treated 1-7 days before operation, 1 case 11 days preoperatively and 2 cases 14 and 16 days preoperatively. For different reasons a strict program could not be followed in all cases. In 7 cases the antifibrinolytic treatment was started immediately in the first week after bleeding, in 5 cases within two weeks and in the remaining 2 cases in the third week. In none of our cases did recurrent bleeding occur during treatment. 2 cases died after operation. In one, recurrent bleeding occurred after inadequate surgery where the aneurysm could not be eliminated by a ligature and a big basal part had to be wrapped with plastic adhesive. The second case is of greater interest. The patient died 18 days after operation. The postoperative course was uneventful for 10 days and then slow deterioration and death occurred without any signs of increased intracranial pressure. At post-mortem bilateral thrombosis of the anterior cerebral arteries was demonstrated.It is quite clear that many problems arise in these cases, in which an accurate evaluation of earl...

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