title: Results of Proactive Surgical Clipping in Poor-Grade Aneurysmal Subarachnoid Hemorrhage: Pattern of Recovery and Predictors of Outcome.
abstract: BACKGROUND
  The outcome associated with the treatment of poor-grade aneurysmal subarachnoid hemorrhage is rather discouraging. Even then, some patients may survive; however, the long-term outcomes and the patterns of recovery of these survivors have not received much attention in the literature.
  
  
  METHODS
  A total of 85 patients (mean age 53.3 years, male/female = 34:51, 98 aneurysms) with post resuscitation Hunt and Hess grades 4 and 5 subarachnoid hemorrhage were studied. Modified Rankin Scale score was used to determine the functional outcome. Different factors were analyzed with uni- and multivariate models for their effect on the functional outcomes after surgery.
  
  
  RESULTS
  A total of 23 patients died in the 30-day perioperative period, whereas 8 patients died at follow-up (n = 31, 36.5%). Nearly 35% and 51% of the survivors obtained favorable short- and long-term functional outcomes, respectively. The presence of a space-occupying hematoma (P = 0.014) and the functional status at discharge significantly affected the long-term functionality (P = 0.004) in our patients. The functional improvement was steady with time (the probability of good outcome at about 2 months of discharge was around 65%, about 55% at 1 year, and 40% at 2 years and then achieved a plateau). Marked improvement occurred in 11% survivors even after 18 months.
  
  
  CONCLUSIONS
  If operated at the earliest opportunity after admission, meaningful survival may be provided to a significant number of patients with poor-grade subarachnoid hemorrhage. The recovery process in the survivors is a dynamic process and considering the late improvements in some, it is advisable be follow them beyond the conventional end points.
authors.affiliation: Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Uttar Pradesh, India. Electronic address: kkdas@sgpgi.ac.in.
authors.forename: Kuntal Kanti
authors.initials: KK
authors.lastname: Das
authors.affiliation: Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Uttar Pradesh, India.
authors.forename: Suyash
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Uttar Pradesh, India.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Sharma
authors.affiliation: Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Uttar Pradesh, India.
authors.forename: Anant
authors.initials: A
authors.lastname: Mehrotra
authors.affiliation: Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Uttar Pradesh, India.
authors.forename: Kamlesh
authors.initials: K
authors.lastname: Bhaisora
authors.affiliation: Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Uttar Pradesh, India.
authors.forename: Jayesh
authors.initials: J
authors.lastname: Sardhara
authors.affiliation: Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Uttar Pradesh, India.
authors.forename: Arun K
authors.initials: AK
authors.lastname: Srivastava
authors.affiliation: Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Uttar Pradesh, India.
authors.forename: Awadesh K
authors.initials: AK
authors.lastname: Jaiswal
authors.affiliation: Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Uttar Pradesh, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Behari
authors.affiliation: Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Uttar Pradesh, India.
authors.forename: Raj
authors.initials: R
authors.lastname: Kumar
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D011182:Postoperative Care; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Aneurysm; Aneurysm surgery; Functional outcome; Long-term outcome; Pattern of recovery; Poor-grade subarachnoid hemorrhage