Management strategy and prognosis analysis for poor-grade aneurysmal subarachnoid hemorrhage

Abstract

Objective To investigate the efficacy of microsurgery and predictors of outcome for poor-grade aneurysmal subarachnoid hemorrhage(aSAH). Methods Clinical data of 43 patients of poor-grade aSAH who performed microsurgery were retrospectively analyzed.There were 30 patients with Hunt-Hess grade IV and 13 patients with grade V.24 patients received emergency operation(within 6hours after onset), 16 patients received ultra-early operation(within first 24hours after onset).Outcome was assessed by Glascow Outcome Scale(GOS). Results Of 43 patients who received microsurgery, favorable outcome was achieved by 19 cases of 43 cases (44.2%), poor outcome was achieved by 16 cases of 43 cases (37.2%), the overall outcome of patients with Hunt-Hess grade IV was better than that with grade V(Z=-2.486, P=0.016).18 patients with intracerebral hematoma received ultra-early or emergency operation, effective surgical intervention(GOS≥3) achieved in 12 patients, there was no significant difference in prognosis between the patients and the others who without intracerebral hematomas(χ2=0.103, P=1.000). Conclusion The ultra-early or emergency surgery could avoid the risk of aneurysmal re-rupture, relieve malignant intracranial hypertension as soon as possible and decrease the mortality of poor-grade aSAH patients. Key words: Subarachnoid hemorrhage; Intracranial aneurysm; Microsurgery