Microsurgical Management of Intracranial Aneurysms After Flow Diversion Failure

Subarachnoid hemorrhage (SAH) occurring after an intracranial aneurysm rupture has an incidence of 10.5 per 100,000 person-years and accounts for about 5% of strokes. The resulting outcome depends on several factors including the severity of the initial hemorrhage, rebleeding, perioperative medical management, and the timing and technical success for aneurysm treatment. The overall mortality rates from 32%−67% with 10%–20% of patients with long-term dependence due to brain damage. It is well known that 12% of patients die before achieving medical treatment and 25% die within the first 24 hours. Again, 40%–60% mortality rate occurs within 30 days. Among the surviving patients, about one third remain dependent3 and only a small minority of all SAH-affected patients has a good outcome. Despite advances in diagnostic, anesthetic, and intraoperative neurosurgical techniques, as well as preoperative and postoperative management of patients, the ultimate overall outcome in patients with aneurysmal SAH remains unsatisfactory. Many studies have explored a number of neuroprotective agents without achieving conclusive results.