PMID: 9165425Sep 1, 1996Paper

Results of early surgery in poor-grade aneurysm patients

Journal of Neurosurgical Sciences
J ZentnerJ Schramm

Abstract

During a 4-year-period (1991-1994) a total of 85 poor-grade [Hunt and Hess (H&H) IV and V] patients were treated for aneurysmal subarachnoid hemorrhage. Patients who were admitted in poor grades but improved after initial treatment were excluded from this study. Overall mortality was 46% (N = 39). In particular, 29% (18 out of 63) of surgically treated patients had died as opposed to 95% (21 out of 22) of conservatively treated patients. Early surgery provided favourable (Glasgow-Outcome-Scores (GOS) 4-5) results in 52% of H&H grade IV patients but only in 22% of grade V patients. In particular, approximately one fourth of grade IV patients had a good outcome and 30% were only moderately disabled. Intracranial pressure (ICP) below 20 mmHg proved to be a favourable prognostic sign. It is concluded that, in consideration of the management mortality encountered with delayed surgery, H&H grade IV patients benefit from early surgical treatment while the prognosis of grade V patients still remains unfavourable.

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