Results of a controlled trial of late surgical versus conservative treatment of intracranial arterial aneurysms

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Abstract
✓ A controlled trial involving 178 subarachnoid hemorrhage patients in good condition (Grade 1) and with single intracranial arterial aneurysms is reported. The decision to treat with stalk ligature or conservatively was made at a comparatively late stage, on an average of 51 days after the initial hemorrhage. After a follow-up time of ½ to over 5 years (average 3½ years), there was no statistical difference between the results in the operated and unoperated groups. The majority of the nine fatal recurrences among the 92 unoperated patients occurred within the first months after initial hemorrhage; only one death occurred later than 4 months after hemorrhage. There was one operative death in the hospital among the 86 operated patients; all the four late deaths from reasons related to the aneurysm occurred in patients who had had operations other than aneurysmal stalk ligatures performed. It is concluded that Grade 1 aneurysm patients have such a good natural prognosis that the value of late surgery seems limited, even if performed without mortality or increased morbidity, and in the form of stalk ligature.