Timing Of Surgery For Ruptured Aneurysms In256Patients:a Retrospective Study

Objectives:The debate continues on the timing of ruptured aneurysms. Someone prefer late surgery because ruptured aneurysms can lead to intracranial hematoma, encephaledema, high intracranial pressure, difficulties in the exposure and procedures of early surgeries; while others hold the view that early surgery could be better. Almost20%of aneurysms rerupture within the first two weeks,75%to85%of patients who rebleed die approximately who lost the opportunities for treatment caused by late surgery. Most hypothesis for timing of ruptured aneurysms will be tested using a retrospective study.Method:Over a14months period between Jan.2011and Mar.2012, patients admitted to our hospital with the diagnosis of aneurysmal subarachnoid hemorrhage (aSAH) have been studied retrospectively. All have been following a strict management protocol for aSAH in our department, of which256patients met the requirements of study and were divided into four groups according to the timing of surgery:super-early group (the time between ictus and surgery is within24hours), early group(1-3days), intermediate group(4-10days) and late group(11-20days) supposing the ictus of aSAH is day0. Modified Rankin Scale grade at6month after surgery is used for the evaluation of patients’ prognosis. The influence of the timing of surgery was analyzed by ANOVA statistical method as well as the age, clinical grade and site of aneurysms.Results:Among256patients,22.7%fell into the super-early group,40.6%into the early group,28.9%into the intermediate group and7.8%into the late group. There was significant difference in Rankin grade between super-early group and late group (p<0.05). For poor clinical grade patients, there was no significant difference in the Rankin score in super-early and early group (p>0.05) but there was significant difference in intermediate and late groups (p=0.0124<0.05, p=0.0019<0.01). For anterior circulation aneurysms, early group got a better prognosis(p=0.0136<0.05) while other groups didn’t. The complications (vasospasm, cerebral infarction, intracranial infection) showed no significant difference between surgical timing groups as well as the age, except rebleeding whose ratio is higher in late group (p<0.0001).Conclusion:There was no significant difference in prognosis between surgical timing groups except the super-early group. For poor clinical grade patients or anterior circulation aneurysm patients, early surgery could make them get a better prognosis. Late surgery would increase the ratio of rebleeding, however, there was no significant difference in other complications between surgical timing groups.