Progress in cerebrovascular disease. Management of XXXX .

@entity1 @entity548 @entity63 @entity438 @entity2553 @entity204 @entity1756
The primary effort of neurosurgery over the past two or three decades has been to deal effectively with @entity438 surgically. Concomitantly with aggressive medical treatment, considerable progress has occurred in the prevention of early rebleeding and the treatment of the @entity63 , the most serious features of the natural history of a @entity1756 . The major problem now becoming evident is that in spite of this progress, the majority of @entity1 are not seen by physicians and there has been only a small impact on the overall morbidity. It is dismaying to realize that many @entity1 go unrecognized, at least until a massive brain-destroying @entity548 has occurred. Only a small fraction of the @entity1 are seen after the initial bleed when the greatest therapeutic reward would occur. The challenge for the future, then, will be the early recognition of the initial @entity548 , the warning @entity548 . It will require public education about the problem in a continuing fashion, as well as continuing emphasis on it for students and physicians. The potential for prevention of @entity204 or dreadful disability is large for thousands in the prime of life each year. While delayed surgery is safe, a significant amount of rebleeding and @entity63 with @entity2553 still occur, resulting in an unsatisfactory overall morbidity. A collaborative study is desirable to determine with sufficient @entity1 whether very early modern operation in many hands will reduce this morbidity.
