Surgical timing and prognosis of patients with Hunt-Hess grade Ⅲ and Ⅳ aneurysms

XU Yuan-yuan; LI Jian-ming; SHEN Hong-bo

doi:10.13798/j.issn.1009-153X.2018.06.009

Abstract：Objective To investigate the relationship between the microsurgical timing and the prognosis of patients with Hunt-Hess grade Ⅲ and Ⅳ aneurysms. Methods The clinical data of 90 patients with Hunt-Hess grade Ⅲ～Ⅳ aneurysms, who were treated by microsurgery in our department from January, 2015 to December, 2017, were analyzed retrospectively. According to the time from onset of rupture to surgery, the patients were divided into 3 groups, i.e. early group (within 3 days after the rupture, 38 cases), medium-term group (3～10 days, 20 cases) and late group (more than 10 days, 32 cases). The short-term prognoses and the incidences of complications were compared among the groups. Results The excellent and good rate of prognosis (89.47％ , 34/38) was significantly higher in the early group than those [(60.00％, 12/20) and (68.75％, 22/32) respectively] in the medium-term group and late group (P＜0.05). The incidence of cerebral vasospasm (5.26％ , 2/38) was significantly lower in the early group than those [(30.00％ , 6/20) and (25.00％ , 8/32) respectively] in the medium-term and late groups (P＜0.05). There were insignificant differences in the excellent and good rate of the prognosis and incidence of cerebral vasospasm between the late and the medium-term groups (P＞0.05). The binary Logsitic regression analysis showed that the short-term prognosis of the early surgical treatment on the Hunt-Hess Ⅲ～Ⅳ patients with ruptured aneurysms was significantly better than those of the medium-term and late microsurgery (OR=1.813, 90％ CI: 1.294～2.641). Conclusion The microsurgical treatment should be performed within 3 days in the Hunt-Hess grade Ⅲ～Ⅳ patients with ruptured intracranial aneurysms in order to improve their prognoses.