title: Causes of unfavorable outcome after early aneurysm operation.
abstract: In a consecutive series of 160 patients in Hunt and Hess Neurological Grades I to III who were operated upon for a ruptured supratentorial aneurysm within 3 days after the hemorrhage, 42 patients (26%) had an unfavorable outcome. Delayed ischemic cerebral dysfunction with permanent deficit accounted for the unfavorable outcome in 18 patients (43% of all unfavorable results or 11% of the total series), whereas the unfavorable outcome was due to deficit ascribed to surgical trauma in 11 patients (26% of all unfavorable results or 7% of the total series) and to the initial hemorrhage in 7 patients (17% of all unfavorable results or 4% of the total series). Impaired outflow of cerebrospinal fluid with shunt dependency occurred in 3% of the total series. Of the patients with an unfavorable outcome, 17 (40%) had had arterial hypertension before the hemorrhage. The incidence of unfavorable outcome in good grade patients (Grades I and II) was not influenced by timing of operation (Day 1, 2, or 3 after hemorrhage). The results favor the opinion that it is principally the patient's condition during the acute stage that determines the outcome. (Neurosurgery 13:629-633, 1983).
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000209:etiology; D002543:Cerebral Hemorrhage / Q000150:complications / Q000401:mortality / Q000601:surgery; D002648:Child; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology; D002532:Intracranial Aneurysm / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008866:Microsurgery / Q000009:adverse effects; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology; D011379:Prognosis; D012422:Rupture, Spontaneous; D013997:Time Factors