Publication year: 2011
Source: World Neurosurgery, Available online 1 November 2011
George Kwok Chu Wong, Ronald Boet, Stephanie Chi Ping Ng, Matthew Chan, Tony Gin, ...
ObjectiveThe timing of definitive aneurysm treatment (coiling or clipping) in acute aneurysm subarachnoid hemorrhage (aSAH) was a subject of controversy. While 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.MethodsTwo-hundred and seventy-six (84%) patients had hemorrhage onset time and aneurysm treatment time available for analysis. P-values less than 0.05 were taken as statistically significant and P-values between 0.05 and 0.10 were considered to be a trend.ResultsFor the 96 poor-grade (WFNS 4-5) patients, there is a significant association between SF-36 mental scores and ultra-early aneurysm treatment (50+/-10 vs 46+/-10, p=0.019) and a trend towards association between ultra-early surgery and favorable neurological outcome (OR 2.4 [95%CI 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.ConclusionsAneurysm treatment performed within the 24-hour window may be associated with better outcome and halve the clinical rebleeding risk in poor grade aneurysmal subarachnoid hemorrhage patients.
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