Grading and timing of surgery for aneurysmal subarachnoid haemorrhage

Among our series of 1519 cases of subarachnoid haemorrhage (SAH) due to aneurysmal rupture, 171 cases (11.3%) died of rebleeding while waiting for surgery mostly within one week after SAH. 1329 cases underwent surgery, 655 cases within one week and 674 cases later than one week after SAH. The mortality at 6 months following SAH was 14.5% in the former group of early surgery, and 3.9% in the latter group of delayed surgery. The latter, however, became 15-29%, if the above 11.3% were added to it. Scrutiny (chi 2-test and U-test) of the outcome at 6 months after SAH revealed the following: Cases of WFNS grade I (GCS: 15) just prior to surgery showed good results regardless of timing of surgery (good recovery: 87.1%, mortality: 2.9%), while WFNS grade IV (GCS: 12-7) and V (GCS: 6-3) cases showed rather poor results regardless of timing of surgery. For WNFS grades II and III cases (GCS: 14-13), surgery on Day 3-7 may better be avoided because of a higher mortality and morbidity due to vasospasm. For cases over 60 years of age, delayed surgery may be preferable especially in higher grade cases.