PROTECTION FROM REBLEEDING BEFORE EARLY ANEURYSM SURGERY

ABSTRACT

Successful surgical or endovascular occlusion of a ruptured intracranial aneurysm virtually eliminates the potential for a recurrent subarachnoid hemorrhage (SAH). Although these procedures are commomly performed in the early period following aneurysmal hemorrhage, the patient remains at risk for a potentially fatal rebleed until the aneurysm is successfully obliterated. A variety of logistic delays invariably prevents the immediate treatment of a ruptured aneurysm. Indeed, the greatest risk for recurrent hemorrhage may be in the first 6-24 hr following the initial rupture, precisely the time during which the patient is undergoing initial assessment.

During a period of 111/2 years, we treated over 1000 patients with a ruptured saccular aneurysm. We have specifically analyzed 467 of these patients with a Hunt and Hess grade of I-III who were scheduled for early surgical intervention. We examined the use of antifibrinolytic therapy prior to early surgery in these patients. We will discuss the rationale for this treatment and provide an update of our results with antifibrinolysis. Also, we will review other strategies that may be beneficial to patients in the early period following aneurysmal SAH. Neurosurgeons need to maintain attention to this relatively brief but critical period between rupture of an aneurysm and its successful occlusion.

KEYWORD

Aneurysm - rebleed - antifibrinolytic therapy

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