Advantage and disadvantages of early and late operation for ruptured cerebral aneurysm are controversially evaluated with regard to peri-operative operation outcome and long-term cognitive recovery. In this retrospective analysis 22 patients with early surgery (ES) within three days after subarachnoid haemorrhage (SAH) and 22 patients with late surgery (LS) at least 14 days after SAH were studied. Patients were pair-wise matched by degree of SAH localisation of aneurysm and age at SAH. On average three years after SAH both groups were examined individually with a comprehensive neuropsychological test battery including tests of premorbid intelligence, concept formation, memory, visuomotor speed, aphasia screening, and mood. ES and LS patients were well comparable in terms of years of education and level of premorbid intelligence. There was a clear influence of patients age on fluid intelligence tests, indicating a general change-sensitivity of tests. No influence of degree of SAH and localisation of aneurysm could be detected. There were also no differences between ES and LS patients in neuropsychological tests sensitive to brain damage, suggesting that the decision for early or late surgery for ruptured cerebral aneurysm can be based upon surgical reasons at the time of the SAH.

Between 1975 and 1989, 58 patients, 32 females and 26 males, mean age 50 years, with intracranial giant aneurysms with a diameter more than 2.5 cm were treated at our clinic. 48% of the patients presented with subarachnoidal hemorrhage. The most of the other 30 patients presented with cranial nerve dysfunctions. The most common site of the aneurysm was the internal carotid artery (25 cases, 43%), followed by the anterior cerebral artery (14%), and the vertebro-basilar region (11 cases, 19%). In 14 patients direct surgery was not performed because of the poor general condition of the patient, the high risks, or non-consent. In seven patients (12%) the aneurysm had been misdiagnosed as meningeoma, pituitary-adenoma, craniopharyngeoma or glioblastoma. 47% of all patients were discharged as "independent" and 19% died. Patients without SAH had better chance of survival: 7% of patients without SAH died and 29% of patients with hemorrhage. 50% of patients without hemorrhage were discharged as "independent" but only 18% of patients with SAH. Because of the high incidence of hemorrhage and the better prognosis for patients without hemorrhage, we recommend routine surgical treatment of patients with giant aneurysms.