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Poor-grade subarachnoid hemorrhage: is surgical clipping worthwhile?

Sunil K Gupta1, Rajesh K Ghanta, Rajesh Chhabra

  • 1Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India. drguptasunil@gmail.com

Neurology India
|April 13, 2011
PubMed

Insights

Early surgical clipping for poor-grade aneurysmal subarachnoid hemorrhage (SAH) significantly improves long-term outcomes. This aggressive approach reduces rebleeding and vasospasm, offering a better chance of survival and recovery for critically ill patients.

Area of Science:

  • Neurosurgery
  • Neurology
  • Critical Care Medicine

Background:

  • Management of poor-grade aneurysmal subarachnoid hemorrhage (SAH) presents significant challenges with variable institutional protocols.
  • Hunt and Hess (H and H) Grade IV and V patients represent a particularly difficult subset requiring specialized care.

Purpose of the Study:

  • To evaluate the efficacy of an aggressive surgical clipping protocol for patients with poor-grade aneurysmal SAH.
  • To assess the impact of early intervention on mortality and long-term functional outcomes in this patient cohort.

Main Methods:

  • A retrospective review of patients undergoing aneurysmal clipping for poor-grade SAH (H and H Grade IV and V).
  • Surgical intervention was performed after hemodynamic and metabolic stabilization.
  • Patient outcomes were categorized as favorable, unfavorable, or dead.

Main Results:

  • Out of 1196 patients, 165 (13.8%) had poor-grade SAH (99 Grade IV, 66 Grade V).
  • Over half (58%) underwent surgery within 24 hours of admission.
  • Overall mortality was 50.9%, with 72% of survivors achieving a favorable long-term outcome.

Conclusions:

  • An aggressive strategy of early clipping for poor-grade aneurysmal SAH reduces rebleeding and allows for more effective vasospasm management.
  • This protocol significantly improves survival rates in patients who might otherwise have succumbed to their condition.
  • Long-term follow-up demonstrates substantial functional improvement in surviving patients post-discharge.
Abstract

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