[Vasospasm and its outcome after early surgery for ruptured cerebral aneurysms: relationship with the clinical grade based on the Glasgow Coma Scale]

Over a 9 year period, 270 patients who had early aneurysm surgery within 7 days after subarachnoid hemorrhage were analyzed regarding occurrence of vasospasm (VS) and its outcome. Occurrence of VS was recognized by ischemic neurological deterioration, with or without CT evidence of infarcts. Surgical outcome was assessed by the Glasgow Outcome Scale 6 months postoperatively. The results were correlated with age, aneurysm site, day of surgery, and preoperative clinical grade evaluated by the Glasgow Coma Scale (GCS). Thirty patients with the GCS sum score of less than 6 were excluded from the analysis of VS. Eighty two patients (34%) developed VS, of which 36 patients (15%) showed ischemic symptoms only, and 46 (19%) had infarct on CT. The incidence of symptomatic VS was 12% in GCS 15 group (117 patients), 23% in GCS 14-13 group (70 patients), and 11% in GCS 12-7 group (53 patients). That of VS with infarct was 14%, 23%, and 26% in GCS 15, GCS 14-13, and GCS 12-7 groups, respectively. Thus, there was a close correlation between the clinical grade based on the GCS and the incidence of VS, especially with infarct. The grade was also useful in predicting the surgical outcome. VS was more common in the older age group. The site of aneurysm or the day of surgery had no apparent influences on the incidence of VS or its outcome. Overall, the incidence of poor outcome due to VS proved to be 12%, which accounted for one-third of the cases in which there was poor outcome due to various causes.