SUBARACHNOID HEMORRHAGES FROM RUPTURED AN EURYSMS - SURGERY OR EMBOLIZATION

Traditionally the aneurysms of the circle of Willis have been an indic ation for neurosurgery. New technologies of endovascular treatment wit h electrically detachable coils resulted in a different therapeutical concept since four years, A series including 140 patients has been tre ated in our institution from 1 January 1992 to 31 December 1994, 94 of them presenting with a subarachnoid haemorrhage. Out of these 140 pat ients, 84 were treated with surgery, 51 with the endovascular techniqu e, five with surgery after incomplete or unsuccessfull endovascular tr eatment. Surgery was indicated in patients presenting early after blee ding, devoid of vasospasm, with a favourable Hunt and Hess grading and in aneurysms located in the anterior part of the circle of Willis, En dovascular treatment was indicated in patients-admitted with delay, wi th severe vasospasm, a poor Hunt and Hess grading and in all aneurysms of the vertebrobasilar arterial network. Age was of less importance i n comparison to the status of the vessels for selection of the method of treatment, Giant aneurysms are difficult to treat as surgery is fac ed with the size of the aneurysm itself acid endovascular technique wi th the width of the aneurysmal neck.