1he timing of surgery for ruptured anterior circulation aneurysms

Abstract

Objeclive To investigate the appropriate timing of surgery for ruptured anterior circulation aneurysms. Methods Eighty-two patients with ruptured anterior circulation aneurysms were analyzed retrospectively. They were divided into the low-grade group （grade Ⅰ to Ⅲ, n =64） and the high-grade group （grade Ⅳ to Ⅴ, n = 18） according to the Hunt ＆ Hess scale on admission. Then they were also divided into early （ ≤ 3 d, n = 45 ）, intermediate （4- 10 d, n =20） and late （≥11 d, n = 12） surgery groups according to their timing of surgery. Surgery were not performed in 5 patients for rebleeding. The outcome at 3 months was scored according to the Glasgow Outcome Scale （GOS）. Results In the low-grade group, the rate of good outcome （GOS 4-5） in the early surgery group was significantly higher than that in the intermediate and late surgery groups （96.3% vs. 75.0%, P =0.031）, and the incidence of the major postoperative complications was significantly lower than that in the intermediate, and late surgery groups （22.2% vs. 46.9%, P =0. 049）; the rate of good outcome in the intermediate surgery group was significantly higher than that in the late surgery group （85.5% vs. 41.7%, P =0. 004）, and the incidence of the major postoperative complications was significantly lower than that in the late surgery group （30. 0% vs. 75.0%, P =0. 027）. The patients in the high- grade group were all operated early,＇ and their rate of good outcome was 55.6%. Conclmiom Early operation is advocated in patients with ruptured anterior circulation aneurysms of different grades. Key words: Intracrnnial aneurysms; Aneurysms, ruptured; Surgery