Related Experiment Videos
Results of early surgery in poor-grade aneurysm patients
J Zentner1, C Hoffmann, J Schramm
1Department of Neurosurgery, University of Bonn, Germany.
Insights
Early surgery improves outcomes for poor-grade aneurysmal subarachnoid hemorrhage patients (Hunt and Hess grades IV and V). While grade IV patients benefit significantly, grade V patients still face unfavorable prognoses despite surgical intervention.
Area of Science:
- Neurosurgery
- Neurology
- Critical Care Medicine
Background:
- Aneurysmal subarachnoid hemorrhage (aSAH) carries significant mortality and morbidity, particularly in poor-grade presentations.
- Hunt and Hess (H&H) grading system stratifies patients based on neurological status, guiding treatment decisions.
Purpose of the Study:
- To evaluate the efficacy of early surgical intervention versus conservative management for poor-grade (H&H IV and V) aSAH patients.
- To determine prognostic factors influencing outcomes in this patient cohort.
Main Methods:
- Retrospective analysis of 85 patients with H&H grade IV and V aSAH treated between 1991-1994.
- Exclusion of patients who improved after initial treatment.
- Comparison of outcomes between surgically and conservatively treated groups.
Main Results:
- Overall mortality was 46%. Surgical treatment resulted in 29% mortality compared to 95% with conservative management.
- Early surgery yielded favorable Glasgow Outcome Scores (GOS 4-5) in 52% of H&H IV patients versus 22% of H&H V patients.
- Lower intracranial pressure (ICP < 20 mmHg) was associated with better prognosis.
Conclusions:
- Early surgical treatment significantly benefits H&H grade IV aSAH patients, improving survival and functional outcomes.
- Despite surgical efforts, H&H grade V patients continue to have an unfavorable prognosis.
- Management mortality associated with delayed surgery underscores the importance of timely intervention for eligible patients.
Methods:
During a 4-year-period (1991-1994) a total of 85 poor-grade [Hunt and Hess (H&H) IV and V] patients were treated for aneurysmal subarachnoid hemorrhage. Patients who were admitted in poor grades but improved after initial treatment were excluded from this study.
Results:
Overall mortality was 46% (N = 39). In particular, 29% (18 out of 63) of surgically treated patients had died as opposed to 95% (21 out of 22) of conservatively treated patients. Early surgery provided favourable (Glasgow-Outcome-Scores (GOS) 4-5) results in 52% of H&H grade IV patients but only in 22% of grade V patients. In particular, approximately one fourth of grade IV patients had a good outcome and 30% were only moderately disabled. Intracranial pressure (ICP) below 20 mmHg proved to be a favourable prognostic sign.
Conclusions:
It is concluded that, in consideration of the management mortality encountered with delayed surgery, H&H grade IV patients benefit from early surgical treatment while the prognosis of grade V patients still remains unfavourable.