Clinical efficacy of microsurgery for treatment of high-grade aneurysmal subarachnoid hemorrhage

Objective To investigate the efficacy of microsurgery for treatment of high-grade aneurysmal subarachnoid hemorrhage (aSAH).Methods The clinical data of 27 patients (28 aneurysms; Hunt-Hess grade Ⅳ or Ⅴ) with aSAH treated in the Department of Neurosurgery, Huashan Hospital, Fudan University, China from 2001 to 2008 were analyzed retrospectively.There were 23 patients with Hunt-Hess grade Ⅳ and 4 with Hunt-Hess grade Ⅴ.A total of 27 aneurysms were clipped, and one was trapped and revascularized.Third ventriculostomy or external ventricular drainage was performed in 13 patients and decompressive craniectomy was performed in 14 patients during the operations.The clinical efficacy of the patients was observed.Results ① Of the 27 patients, 8 were died after operation.The causes of death were intraoperative bleeding caused postoperative cerebral infarction (2 cases) ; postoperative severe vasospasm caused massive cerebral infarction (6 cases).Six patients had residual unilateral limb muscle strength decline at discharge, 5 had disorientation, and 4 were unconsciousness.②Nineteen patient had postoperative pulmonary infections, 20 had electrolyte disturbance, and 6 had arrhythmia.③The patents were followed up for 15～96 months(mean 47 months) .Two patents died during the follow-up period. The good recovery rate of general efficacy was 51.9% (14/27) , the poor prognosis rate was 11.1% (3/27) , and the mortality rate was 37.0% (10/27).④Different age, Hunt-Hess grade, preoperative Glasgow outcome scale (GOS) score, time from bleeding to operation, and with or without acute hydro- cephalus were the factors, affecting the prognosis of patients.The preoperative GOS score was the only factor had statistically significant difference.Conclusion The prognosis of patients with high-grade aSAH was associated with multiple factors.Selecting proper treatment modality according to the conditions of patients may improve the prognosis of the patients with high-grade aSAH.