title: Ultra-early (within 24 hours) aneurysm treatment after subarachnoid hemorrhage.
abstract: BACKGROUND
  The timing of definitive aneurysm treatment (coiling or clipping) in acute aneurysm subarachnoid hemorrhage was a subject of controversy. Although most vascular neurosurgeons agreed on early aneurysm treatment (within the first 72 hours), whether ultra-early aneurysm treatment (within the first 24 hours) was beneficial remained debatable. We aimed to investigate whether ultra-early aneurysm treatment is associated with better neurological outcome in all patients or only good-grade patients or only poor-grade patients.
  
  
  METHODS
  Two-hundred and seventy-six (84%) patients had hemorrhage onset time and aneurysm treatment time available for analysis. Values of P < 0.05 were taken as statistically significant, and P values between 0.05 and 0.10 were considered to be a trend.
  
  
  RESULTS
  For the 96 poor-grade (World Federation of Neurological Surgeons grading scale 4 to 5) patients, there was a significant association between Short Form-36 mental scores and ultra-early aneurysm treatment (50 ± 10 vs. 46 ± 10, P = 0.019) and a trend toward association between ultra-early surgery and favorable neurological outcome (odds ratio 2.4 [95% confidence interval 1.0 to 6.0], P = 0.062). A reduction in clinical rebleeding (12% vs. 22%, P = 0.168) was observed in patients undergoing ultra-early aneurysm treatment.
  
  
  CONCLUSIONS
  Aneurysm treatment performed within the 24-hour window may be associated with a better outcome and halve the clinical rebleeding risk in poor-grade aneurysmal subarachnoid hemorrhage patients.
authors: Division of Neurosurgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China. georgewong@surgery.cuhk.edu.hk
authors: George Kwok Chu
authors: GK
authors: Wong
authors: Ronald
authors: R
authors: Boet
authors: Stephanie Chi Ping
authors: SC
authors: Ng
authors: Matthew
authors: M
authors: Chan
authors: Tony
authors: T
authors: Gin
authors: Benny
authors: B
authors: Zee
authors: Wai Sang
authors: WS
authors: Poon
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000601:surgery; D002533:Cerebral Angiography; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D013345:Subarachnoid Hemorrhage / Q000601:surgery*; D013525:Surgical Instruments; D016896:Treatment Outcome