The Relationship of Neurological Status and the Angiographical Evidence of Spasm to Prognosis in Patients With Ruptured Intracranial Saccular Aneurysms

A retrospective analysis of 79 patients admitted to the Neurosurgery Department, Rigshospitalet, Copenhagen, Denmark, from January, 1969, through May, 1971, was performed. The clinical grading was performed according to a modification of the scheme of Hunt and Hess.1 All patients were evaluated with angiography. Twenty-five of the 79 patients had preoperative angiographical evidence of spasm. Surgery was delayed for a mean period of 15 days in the majority of patients except for those with significant mass effects. Sixty-two of the 79 patients reached operation. Fortysix of the 62 patients had angiography performed immediately upon completion of surgery. Twenty-two of the 46 patients had angiographical evidence of spasm immediately postoperatively. The eventual outcome of all of the patients is evaluated according to the clinical grade and the presence of spasm preoperatively and postoperatively. The high incidence of spasm immediately after surgery shows that spasm is not a delayed phenomenon as is suggested by clinical evaluation. Methods for treating spasm should be started at the time of surgery.