title: Patients with supratentorial aneurysmal subarachnoid hemorrhage during the intermediate period: waiting or actively treating.
abstract: Perhaps the most difficult practical decision for neurosurgeons these days is whether to secure aneurysms during the intermediate period (4-10 days) after aneurysmal subarachnoid hemorrhage (SAH). We reviewed retrospectively a series of 115 patients with a Hunt-Hess grade I-III upon admission who were admitted 4-10 days after initial supratentorial aneurysmal SAH. Patients who underwent active treatment in the intermediate period were assigned to the intermediate group (n = 49), while those who accepted delayed obliteration of a ruptured aneurysm (11-30 days) were assigned to the late group (n = 66). The demographic characteristics, size and site of aneurysms, and clinical conditions were well balanced in the two groups. There was no difference in outcome between the two groups according to the Glasgow Outcome Scale (GOS) at discharge or a 6-month follow-up. Rebleeding before aneurysms obliteration was the leading factor resulting in poor outcome. In conclusion, for patients with supratentorial aneurysmal SAH who were in good clinical condition upon admission, active treatment during the intermediate period offered a good chance for a favorable outcome. An even larger number of patients from randomized clinical trials might be necessary to draw more reliable conclusions.
authors.affiliation: Department of Neurosurgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, P.R. China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Tong
authors.forename: Jun
authors.initials: J
authors.lastname: Gu
authors.forename: Wei-Jian
authors.initials: WJ
authors.lastname: Fan
authors.forename: Jian-Bo
authors.initials: JB
authors.lastname: Yu
authors.forename: Jian-Wei
authors.initials: JW
authors.lastname: Pan
authors.forename: Shu
authors.initials: S
authors.lastname: Wan
authors.forename: Yong-Qing
authors.initials: YQ
authors.lastname: Zhou
authors.forename: Xiu-Jue
authors.initials: XJ
authors.lastname: Zheng
authors.forename: Ren-Ya
authors.initials: RY
authors.lastname: Zhan
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000601:surgery; D015901:Angiography, Digital Subtraction; D002545:Brain Ischemia / Q000601:surgery / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome