"Ultraearly" aneurysm surgery

Three hundred and twenty-seven patients with intracranial aneurysm were managed at the Neurosurgical Division of Emergency Department of the Cardarelli Hospital of Naples. Of the 327 patient, 231 (70.6%), (I group), were operated on after 72 hours and 96 patients (29.4%), (II group), were operated on within 72 hours of subaracnoid hemorrhage. The patients operated on within 72 hours of hemorrhage (II group) were divided in two subgroups: 29 patients operated on within 72 hours formed the IIa group ("ultraearly" surgery) and 67 patients operated on between 24-72 hours formed the IIb group. Poor clinical grades (IV and V Hunt and Hess grades) were excluded from this study. Glasgow outcome scale (GOS), simplified in three grades was used to evaluate the results (GOS 1 good recovery; GOS 2 moderate or severe disability, and GOS 3 dead). The outcome was evaluated at the dimission and at 6 months. The best results seem to be for the patients in group IIb (24-72 hours), but if we consider that 31.2% of the patients operated on within 24 hours (IIa group) were in grade III of Hunt and Hess classification, also for these patients the surgical results seem to be good. The clinical presentation, treatment and outcome are discussed in this report.