Analysis of reruptured cerebral aneurysms and the prophylactic effects of barbiturate therapy on the early stage

Ultra-early surgery for aneurysmal subarachnoid hemorrhage: outcomes for a consecutive series of 391 patients not selected by grade or age

“…Our regimen of ultra-early surgery is based on the now well-documented risk of rebleeding, which is highest within the first 6 to 12 hours after SAH. 1,2,4,24,33,41 Our series confirms that risk with a 12% ultra-early (Յ 12 hours post-SAH) rebleeding rate. This series cannot add to the debate between the relative merits of surgical and endovascular treatment of aneurysms, because the study period encompassed a time when we were unable to offer endovascular therapy routinely for aneurysms.…”

“…

HE term "early surgery," which applies to an operation performed within 3 days after onset of SAH, is, of course, somewhat misleading if we consider that the rebleeding rate in patients who have suffered this hemorrhage is highest within the first 24 hours, 2,4,24,33,41 with up to 87.1% of rebleedings occurring within the first 6 hours after SAH. 24 Therefore early surgery performed on the 2nd or 3rd day post-SAH would seem to be somewhat delayed, and would not be expected to have a major impact on the rebleeding rate.

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Sentinel Headache and the Risk of Rebleeding After Aneurysmal Subarachnoid Hemorrhage

“…5,10,12,18,19,20 In the current study, 40% of rebleeding events occurred in the first 6 hours. Fujii et al 5 even found that 17.3% of their patients experienced ultraearly rebleeding, with 87.1% of these patients having rebleeding within 6 hours.…”

Poor-grade subarachnoid hemorrhage: Is surgical clipping worthwhile?

“…[1][2][3][4][6][7][8][9][10] While one cannot do much about the primary brain damage, rebleed and vasospasm are potentially treatable conditions. It is well documented that the highest rebleeding after SAH occurs within the first 24 h. [19][20][21][22][23] There is also evidence that the rebleeding rate is actually higher in poor-grade patients than in good-grade patients. [5,7,[24][25][26][27][28] In recent years, there have been reports of aggressive surgical management of poor-grade SAH patients with significant proportions of patients achieving good results.…”