The Follow-up Of Surgical Treatment For Poor-grade Aneurysmal Subarachnoid Hemorrhage

Intracranial aneurysms(AN)are abnormal protrusion on the walls of intracranial arteries.They are the primary causes of subarachniod hemorrhage(SAH).The poor-grade intracranial ruptured aneurysm refers to Hunt-Hess grade Ⅳ to Ⅴ,which accounts for 20%to 30%of the aneurysmal subarachnoid hemorrhage.Aneurysmal subarachnoid hemorrhage has a high mortality rate,while high grade aneurysmal subarachnoid hemorrhage has a higher risk.Although with the development of science and technology,neurosurgeons are improving the treatment of aneurysms,patients’s postoperative morbidity and mortality is still as high as 60%.At the same time,there are still many controversies on the treatment timing and treatment of poor-grade patients with ruptured intracranial aneurysms.Objective:To investigate the treatment and prognostic factors of patients with high grade aneurysmal subarachnoid hemorrhage.Methods:The clinical datd of 24 patients with intracranial aneurysmal subarachnoid hemorrhage(grade Ⅳ,n=20 and grade Ⅴ,n=4)Hunt-Hess gradeⅣ-Ⅴ admitted from April 2011 to July 2017 in Department of Neurosurgery,the Third Hospital of Southern Medical University were analyzed retrospectively.The age of patients,the gender of patients,complicated with hypertension or diabetes,smoking history,Hunt-Hess grade on admission,bleeding times,modified Fisher grade,locations of guilty aneurysms,aneurysm size,having acute hydrocephalus or not,having intracerebral hematoma or not,having intraventricular hemorrhage or not,having cerebral hernia or not,treatment modality,the timing of intervention,analgesic and sedative treatment or not were registered.The modified Rankin scale(mRS)was used to assess the prognosis of the patients.Results:According to the modified Rankin scale,good recovery was observed in 12 patients,bad recovery in 12 patients.The univariate analysis showed that a poor outcome occureed in patients whose age was more 65 years old(P=0.028),aneurysm diameter was more than 5mm(P=0.041),with acute hydrocephalus(P=0.028),with hypertension(P=0.041)and with analgesic and sedative treatment(P=0.025).In univariate analysis,the age,hypertension,with acute hydrocephalus,aneurysm diameter was more than 5 mm and with analgesic and sedative treatment were used as the independent variables for multivariate analysis,the results showed that age(OR=3.44,95%CI:1.58～14.23;P=0.014)、hypertension(OR=5.68,95%CI:3.24～19.83,P=0.026)、aneurysm size(OR=8.43,95%CI:2.56～24.46,P= 0.037)were the independent factors of affecting the prognosis.There was a significant difference in the mortality rate in the Hunt-Hess IV patients at different surgical timing groups(P=0.018).Conclusion:For poor-grade aneurysmal subarachnoid hemorrhage,early aggressive surgical treatment can achieve satisfactory efficacy.The age of patients,complicated with hypertension,aneurysm size,having acute hydrocephalus or not and analgesic and sedative treatment were closely related to the prognosis of patients after procedure.The age of patients、hypertension、aneurysm size were the independent factors of affecting the prognosis As for the patients with grade IV, ultra-early operation may help to reduce mortality rate.