Surgical Intervention Of Subacute Aneurismal Subarachnoid Hemorrhage

Objective: To analyze the difficulty and risk of the surgical intervention of the patients with subacute aneurismal subacrachnoid hemorrhage(SAH), to approach the foundation and condition of the treatment, and to evaluate the feasibility of the immediate surgical intervention of the patients with subacute aneurismal SAH. Method: A series of 87 patients conescutively admitted to our hospital between Jan, 2001 and Jun, 2007 with the diagnosis of aneurismal SAH were retrospectively reviewed. These patients lost the early therapeutic opportunity because of delayed-transportation or hesitation in decision. Patients who underwent intermediate clipping or coiling (days 4-14)were subjected to the intermediate group (n=28) while the other patients accepted delayed therapy for ruptured aneurysm (days>14) were subjected to the late group (n=59). Outcome was assessed by means of the Glasgow Outcome Scale measured 6 months after hospital discharge. Differences between the Hunt-Hess Grades or the Glasgow Coma Scale(GCS)of the two groups were computed by SPSS 13.0.Results: There were no significant differences of Hunt-Hess scales on admission, before operation or 24h or 72h after operation between the intermediate group and late group, though there was a tendency that the Hunt-Hess Grades was higher in the intermediate group than in the late group 72h after operation. Four patients rebled before operation, 1 in the intermediate group and 3 in the late group while they are waiting for the operation. When comparing the GOS after 6 months of follow-up, there was no difference between the two groups. Conclusion: In this observational study we found no significant difference in outcome between intermediate group and late group. The intermediate therapy was preferred for patients who were stable but lost the opportunity of early clipping or coiling the ruptured aneurysms. And the patients with high risk of rebleeding are suggested to be treated within the subacute stage. Endosaccular aneurysm coiling offers good chance for poor-grade and high-risk patients during the intermediate period.