Management of subarachnoid haemorrhage.

Faced with a high rate of recurrent bleeding after subarachnoid hemorrhage (SAH)—highest in the first 24 h, accumulating up to 20% in the first 2 weeks—and with the increasing incidence of delayed cerebral ischemia, particularly after the use of antifibrinolytics, we started to operate on ruptured cerebral aneurysms as early as possible (usually within 72 h after the bleeding) since 1979. We assumed that the higher operative mortality and morbidity of early surgery would still be an improvement over the increased mortality and morbidity from recurrent bleeding and an increased rate of delayed cerebral ischemia in delayed surgery.