Management of good-grade intracranial aneurysms

In this retrospective study over a 6-year period, 205 patients in good neurological condition with aneurysms were treated at Louisiana State University Health Sciences Center--Shreveport. Of the 205 patients, there were 120 patients in Hunt and Hess Grade I, 52 patients in grade II, and 32 patients in grade III; 84 aneurysms were unruptured. Ninety-six patients reached the hospital within 3 days of subarachnoid hemorrhage, 77 on the first day. The majority underwent surgery within 3 days of presentation (N = 141). A good outcome was observed in 190 patients; 3 patients died (1 in grade II and 2 in grade III). The outcome was significantly influenced by Hunt & Hess Grade at admission, location of the aneurysm, and size of the aneurysm. Aneurysms of the posterior circulation and aneurysms with larger sacs had significantly worse outcomes than aneurysms in the anterior circulation. No patients in grade I died, and there was no mortality in the patients with unruptured aneurysms. The overall mortality was 1.5% and the morbidity was 4.5%.