Aneurysmal subarachnoid hemorrhage (aSAH) is caused by the rupture of intracranial aneurysms. Although it represents a small proportion of cerebrovascular accidents, aSAH leads to a disproportionately high morbidity and mortality. Twenty-five percent of cerebrovascular mortality is due to aSAH (1), which represents only 3% of all strokes (2). The case-fatality rate is reported to be between 25% and 67% (1,3 ) . Of those who survive, 50% have a disability requiring aid in performing activities of daily living (1,4). Refinements of diagnostic tools, such as computed tomography angiography (CTA) and magnetic resonance angiography (MRA), as well as the advent of therapeutic options in the field of endovascular interventional neuroradi-ology, have facilitated treatment for these patients, but they have also presented new challenges in management decisions for health care professionals. In this chapter, we will focus on the surgical management of aSAH and briefly discuss the presentation, diagnosis, and grading of SAH, as well as the prognostic factors and treatment options.

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