Early Surgery for Poor-Grade Aneurysmal Subarachnoid Hemorrhage

Kim, Yeon Su; Kim, Kwang Myung; Kim, Jae Min; Bak, Kwang Hum; Shin, Hyung Shik; Kim, Young Soo; Ko, Yong; Oh, Seong Hoon; Oh, Suck Jun; Kim, Nam Kyu

Abstract

In order to determine the effect of early surgery on poor grade subarachnoid hemorrhage(SAH) patients. 88 such patients were evaluated between January, 1990 and January, 1996. Clinical grade on admission was Hunt-Hess grade IV(n=58) and V(n=30). The protocol involved the use of computed tomography(CT) scanning to diagnose SAH and to obtain evidence of the destruction of vital brain function, involving massive cerebral infarction with midline shift, dominant basal ganglia or brain stem hematoma. Patients were assigned to either the early surgery group(n=54: surgery performed within 3 days of the first hemorrhage) or the non-surgical group(n=33). In seventeen of 58 in Hunt-Hess grade IV patients, the outcome was good(GOS 4 and 5); 15 of these were in the early surgery group. In only one of 30 Hunt Hess grade V patients was there a good outcome, however. Among Hunt-Hess grade IV patients, mortality was 36.8% in the early surgery group and 60% in the non-surgical group; in the Hunt-Hess grade V group, the corresponding figures were 75% and 100%. In conclusion, it is recommended that to prevent rebleeding and other complications, Hunt-Hess grade IV patients, especially those that showing destruction of vital brain function, should undergo early surgery. With regard to early surgery, non-operation and the existence of evidence of destruction of vital brain function, grade V patients showed no difference in terms of their mortality and morbidity rate.