VERTEBROBASILAR ANEURYSMS - DOES DELAYED SURGERY REPRESENT THE BEST SURGICAL STRATEGY

The appropriate time to perform surgery for posterior circulation aneu rysms is debated. Controversy exists secondary to the lack of informat ion regarding the overall management and outcome, as well as difficult ies with their surgical treatment and infrequent occurrence. The prese nt study examines the results of 46 patients with ruptured vertebro-ba silar aneurysms treated with a delayed surgical protocol. Twenty-four were Hunt-Hess grade I/II on admission, 13 were grade III, and 9 grade IV/V. Nineteen patients (40%) (4 grade I/II, 6 grade III, and the 9 g rade IV/V on admission) died before meeting the required conditions fo r surgery. Causes of death were vasospasm (8 cases), direct effect of the initial bleeding (7 cases), and rebleeding (4 cases). Surgical res ults were excellent/good in 87% of the patients. Surgical mortality wa s 8% (2 out of 24). In this study, despite encouraging surgical result s, overall mortality was disappointingly high. We suggest that as more experience is gained in treating vertebrobasilar aneurysms, early sur gery should be performed in selected cases. Early surgery is prophylac tic for rebleeding and allows for more aggressive treatment of cerebra l vasospasm.