ABSTRACT

Throughout the oral and clinical neurosurgical examination, will be provided with different scenarios for management. Must listen to the examiner and understand the question being asked. There are endless pitfalls. If there are no further details about the given scenario, then begin by mentioning the key factors that determine the management of a ruptured aneurysm. The key factors include Glasgow Coma Scale (GCS) rate of deterioration, age, size of haematoma and evidence of mass effect. In patients with low GCS who rapidly deteriorated and harbour a large intracranial haematoma, then the priority is to treat the increased intracranial pressure by medical optimization followed by craniotomy to evacuate the haematoma and clip the aneurysm. The key to this scenario is to focus on the management of the subarachnoid haemorrhage and consider the influence of the pregnancy on the recommended treatments. The management options depend on patient selection and the underlying aneurysm.