Surgical Intervention

The high risks of rebleeding, poor medical management options for treating vasospasm in the setting of an unsecured aneurysm, and time course of vasospasm are all factors that make prompt, definitive surgical intervention the best therapy. Neurosurgical treatment of aneurysms began in 1937, when Walter Dandy surgically treated the first aneurysm patient at Johns Hopkins Hospital. Modern microsurgical treatment of aneurysm evolved in the 1960s and 1970s under the innovative leadership of Charles Drake and Gazi Yasargil, who incorporated the use of the operating microscope for clipping of aneurysms. Since then, the techniques of microneurosur-gery and skull-base surgery have reached maturity, and aneurysm clips are routinely used to occlude the neck of the aneurysm and exclude the weak saccular portion from the cerebral circulation.

Table 5 Glasgow Coma Scale for Aneurysmal Subarachnoid Hemorrhage

Grade GCS score

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