Medical treatment of subarachnoid hemorrhage due to rupture of an intracranial saccular aneurysm [LA TERAPIA MEDICA NEL TRATTAMENTO DELL'EMORRAGIA SUBARACNOIDEA DA ROTTURA DI ANEURISMA SACCULARE INTRACRANICO]

The author has reviewed the problem of conservative care of subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysms. A retrospective study was performed, comparing two different antifibrinolytic therapeutic modalities, in order to investigate whether one of the two would have led to lower complications rate. 131 patients with recently ruptured intracranial aneurysms were treated according to two different methodics: AMCA, 3 gm/day, combined with Aprotinine, 3-400,000 K.I.U./day; and AMCA, 6 gm/day. Patients of both differently treated groups showed similar rate of rebleeding and of thromboembolic complications, while those treated with the modality 'B' showed a higher rate of ischemic complications and of post-SAH hydrocephalus. The fact that this study is retrospective leads to consider carefully the above results. Nevertheless, there are reasonable preliminaries in order to support a larger use of this modality 'A'. The question of surgical timing is also briefly discussed. In the last years most surgeons were used to operate not less than 8-10 days after SAH. However, recently several authors have supported early surgery, mainly on the basis of pathophysiological considerations. A New Multicenter International Cooperative Study has been organized in order to correlate the results of surgical management of intracranial aneurysms to the interval SAH-operation. This would possible give an important contribution to the clarification of this debated problem.