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Published on: August 11, 2015
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
Summary
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.
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