title: Ultra-early surgery for poor-grade intracranial aneurysmal subarachnoid hemorrhage: a preliminary study.
abstract: OBJECTIVE
  To describe the therapeutic effect and possibility of the ultra-early surgery for poor-grade aneurysmal subarachnoid hemorrhage (Hunt-Hess grades IV-V).
  
  
  METHODS
  Nine cases with intracranial aneurysms, demonstrated by computed tomographic angiography (CTA), were treated by ultra-early surgery under general anesthesia within 24 hours from subarachnoid hemorrhage (SAH), 5 cases were treated within 6 hours and 4 cases in 6 - 24 hours. Preoperative Hunt-Hess grade: 6 cases were IV and 3 cases were V. The clinical outcome was evaluated by Glasgow Outcome Scores (GOS).
  
  
  RESULTS
  In operation, difficult dissection occurred in 5 cases (55.6%), and rupture of aneurysm occurred and temporary obstructions were performed in 4 cases (44.4%). After clipping of aneurysm, 2 cases underwent V-P shunt because of hydrocephalus, pulmonary infection occurred in 3 cases, hypothalamus reaction accompanied with upper gastrointestinal hemorrhage in 2 cases. The clinical outcome were favorable (GOS 4-5) in 4 cases (44.4%), dissatisfied (GOS 2-3) in 3 cases (33.3%), and dead (GOS 1) in 2 cases (22.2%) when patients departed from our hospital.
  
  
  CONCLUSIONS
  The ultra-early surgery can avoid early rebleeding of intracranial aneurysm, therefore, should be considered in the treatment of Hunt-Hess grade IV-V intracranial aneurysms. The appliance of CTA can make it possible to use of ultra-early surgery and improve the therapeutic effect.
authors.affiliation: Department of Neurosurgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Jian-Wei
authors.initials: JW
authors.lastname: Pan
authors.forename: Ren-Ya
authors.initials: RY
authors.lastname: Zhan
authors.forename: Liang
authors.initials: L
authors.lastname: Wen
authors.forename: Ying
authors.initials: Y
authors.lastname: Tong
authors.forename: Shu
authors.initials: S
authors.lastname: Wan
authors.forename: Yong-Ying
authors.initials: YY
authors.lastname: Zhou
mesh_terms: D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000473:pathology / Q000601:surgery*