For poor grade patients with difficult lesions, it may be prudent to wait for neuroloical improvement. Distal basilar aneurysms. Because of their location, broad base, and intimate association with thalmoperforating vessels, these lesions are usually not well-served by an urgent operation. Thrombotic giant aneurysms. In general, it is advisable to wait a few days but an operation should be performed prior to the peak of vasospasm.
Urgent operation is indicated as long as some evidence of brainstem function remains.
All patients rendered comatose by the hemorrhage will die if not decompressed. Advantages of Delayed Surgery 1. The Internation Cooperative Study on timing of surgery showed that neither early nor late surgery emerged as clearly preferable. Nevertheless, there was no significant difference in overall outcome related to timing of surgery. Risk of akinetic mutism.