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We review advances in treatment of ruptured cerebral aneurysm and cerebral vasospasm following subarachnoid hemorrhage (SAH) over the past 30 years. There have been several potent drugs and irrigation methods for subarachnoid clot removal, which were accompanied by attenuated incidence of symptomatic vasospasm in each study. On the other hand, recent advances such as coil embolization and development of surgical techniques enable us to treat older SAH patients in worse clinical grades. However, these advances have not always improved overall clinical outcomes after SAH. At present, the outcome for as much as 40-50% of SAH patients is dependent (MD+SD+vegetative) or dead. Symptomatic vasospasm is one of the main causes of poor clinical outcome, and about 10% of patients have experienced symptomatic vasospasm that resulted in permanent neurological deficit as a sequel. The increased number of elderly patients with SAH, who tend to show worse clinical grades and thereby worse clinical outcomes, may be one of main factors leading to unfavorable results of overall clinical outcome after SAH.
