OVERALL MANAGEMENT OUTCOME OF RUPTURED POSTERIOR-FOSSA ANEURYSMS

A study of the overall management of ruptured posterior fossa aneurysm s was conducted over a 1-year period (1993) in five neurosurgical cent ers in Sweden, serving a population of 6.93 million people. Forty-nine cases were identified and treated. One-third of the patients were in the seventh or eighth decade of life. Good overall management outcomes at 6 months were achieved in 30 cases (61%). The overall mortality ra te was 27%. Patients with Hunt and Hess Grades I and II had a good ove rall recovery rate of 87%. On admission, 69% of the patients were assi gned Hunt and Hess Grades III to V. The impact on patient outcomes of the intraoperative difficulties encountered, especially in the basilar tip area, is stressed. The authors found that delayed operation is no t warranted in most cases. Frequent devastating rebleeding was observe d among patients not offered early aneurysm clipping and the operative results were not at significant variance between the early and late s urgical groups. Only 50% of the patients scheduled for delayed surgery ultimately made a good recovery, whereas 72% of patients scheduled fo r early operation did so. The data demonstrate that overall management results with posterior fossa aneurysms, comparable to achievements wi th supratentorial lesions, are within the reach of modern strategies, even in centers not specializing in these problems.