1203 Early Surgery on Patients with Aneurysmal Subarachnoid Haemorrhage WFNS Grades 4 and 5

Abstract

Abstract Aim This review aims to evaluate timing and approach of management of poor-grade aneurysmal subarachnoid haemorrhage, WFNS grade IV and V. Method We used PubMed, Cochrane Library, and the reviews and reference lists of relevant articles to search for studies published from 1999 till 2018 to review 16 articles, with a total of 2032 patients, for ultra-early, early, or late timing of surgery and 7 articles, with a total of 1294 patients, for surgical clipping or endovascular coiling. Results Studying the outcome of timing of surgery of total population revealed, 50.6% of patients had favourable outcome: 18.4% receiving ultra-early surgery, 20.5% early and 11.8% late surgery. While 42.6% of patients had poor outcome: 20.2% undergoing ultra-early surgery, 14.3% early surgery and 8% late surgery. Analysing the total population for modality of choice revealed, 25.6% of patients who underwent surgical clipping had favourable outcome compared to 15.8% who received endovascular coiling, while 32.1% and 20.9% of patients had unfavourable outcome. In addition to 3.9% of patients refusing the aneurysmal treatment, all suffered poor outcome. Conclusions All the reviewed articles agreed on the consensus that management within 24 hours from ictus is the timing of choice in managing poor grade SAH, which can reduce the increased intracranial pressure and increase cerebral perfusion to improve outcomes. Outcomes of both neurosurgical clipping and endovascular coiling were not appreciably different. However, clipping is preferred in small aneurysm with wide neck and MCA aneurysms. Coiling is preferred in larger aneurysms and aneurysms in ICA and posterior circulation.