Patients with supratentorial aneurysmal subarachnoid hemorrhage during the intermediate period: waiting or actively treating.
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 retrospectively reviewed 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 six-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 of a favorable outcome. An even larger number of patients from randomized clinical trials might be necessary to draw more reliable conclusions.
Tong
Ying
Y
Department of Neurosurgery, The First Affiliated Hospital, College of Medicine Zhejiang University, Hangzhou, P.R. China.
Gu
Jun
J
Fan
Wei-Jian
WJ
Yu
Jian-Bo
JB
Pan
Jian-Wei
JW
Wan
Shu
S
Zhou
Yong-Qing
YQ
Zheng
Xiu-Jue
XJ
Zhan
Ren-Ya
RY
D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000209:etiology* / Q000503:physiopathology; D015901:Angiography, Digital Subtraction; D002548:Cerebral Revascularization / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D014054:Tomography; D016896:Treatment Outcome