Non-surgical treatment after intracranial aneurysm rupture and bleeding 1. Prevent rebleeding: including absolute bed rest, analgesic, antiepileptic, tranquilizer, laxative drugs to keep the patient quiet and avoid emotional agitation. Apply antifibrinolytic agents (aminocaproic acid, anticoagulant acid, phalloidin inhibition, etc.). Before aneurysm management, controlling blood pressure is one of the important measures to prevent and reduce rebleeding of aneurysm, but lowering blood pressure too low can cause damage due to insufficient cerebral perfusion. Usually a 10% to 20% reduction is sufficient. 2.Lowering intracranial pressure: Increased intracranial pressure may occur after subarachnoid hemorrhage, and mannitol can be applied. However, the application of mannitol increases blood volume and increases the average blood pressure, which also occasionally has the risk of rupture of aneurysm. 3.Drainage of cerebrospinal fluid: In the acute stage after aneurysm hemorrhage, there may be a large amount of blood accumulation on the brain surface and inside the brain to increase the intracranial pressure. In some cases, small hematoma or clot may block the interventricular foramen or cerebral aqueduct, causing acute hydrocephalus and impaired consciousness, and emergency ventricular drainage is needed. Lumbar puncture and lumbar pool drainage can also be used as a method of cerebrospinal fluid drainage, but they may cause patients to develop brain herniation crisis in a high cranial pressure state. 4. Prevention and control of cerebral vasospasm: After the rupture and bleeding of aneurysm, the blood entering into the subarachnoid space may easily lead to cerebral vasospasm. Cerebrovascular spasm starts to appear 3-4 days after hemorrhage, reaches a peak in 7-10 days, and starts to subside in 10-14 days. Current treatment of cerebral vasospasm revolves around three main areas: application of calcium antagonists; removal of bloody cerebrospinal fluid; and appropriate blood pressure elevation. Surgical treatment of intracranial aneurysm Surgical treatment of aneurysm includes craniotomy and endovascular intervention. 1.Aneurysm neck clamping or ligation: the purpose of surgery is to block the blood supply of aneurysm to avoid rebleeding; keep the aneurysm-carrying and blood supplying arteries continue to be open to maintain normal blood flow of brain tissue. 2.Aneurysm isolation surgery: Aneurysm isolation surgery is performed to isolate the aneurysm from the blood circulation by clamping the aneurysm-carrying artery at the distal and proximal ends of the aneurysm at the same time. 3.Aneurysm encapsulation: Different materials are used to reinforce the aneurysm wall, which can reduce the chance of rupture although the aneurysm cavity is still filled with blood. At present, the clinical applications include fascia and cotton wire. 4.Interventional intravascular treatment: For patients with aneurysm who are at extremely high risk of craniotomy, fail in craniotomy, or are not suitable for craniotomy due to the systemic and local conditions, intravascular embolization can be used. For aneurysms without the above conditions, embolization treatment can also be chosen first. The purpose of endovascular intervention is to use a femoral artery puncture to place a thin microcatheter inside the aneurysm sac or at the neck of the aneurysm, and then send a soft titanium spring coil through the microcatheter into the aneurysm sac and fill it, so that the blood flow inside the aneurysm sac disappears, thus eliminating the risk of re-rupture and bleeding. Prognosis The prognosis of intracranial aneurysm depends on the patient’s age, the presence of other diseases before surgery, the size, location and nature of the aneurysm, the clinical classification status before surgery, the choice of surgery time, the presence of vasospasm and its severity, especially in patients with subarachnoid hemorrhage accompanied by vasospasm and intracranial hematoma are important factors affecting the prognosis. The experience and technical proficiency of the surgeon, whether microsurgery is used, and whether there is an increase in intracranial pressure after surgery (whether decompression is adequate or not) are all very closely related to the prognosis. The prognosis of patients who are older, with heart, kidney, liver, lung and other important organ disorders as well as hypertension is poor. High preoperative Hunt-Hess classification and posterior circulation aneurysms have a higher operative mortality rate. Disease prevention There is no way to prevent the occurrence of intracranial aneurysms. For those with risk factors, regular cerebrovascular imaging is recommended to detect and treat the lesion before it ruptures and bleeds. Risk factors should be controlled in order to reduce the incidence of aneurysms.