| Objective:To study compared surgical clipping (including preoperative ventricular drainage, surgery to remove the hematoma and decompressive craniectomy), interventional treatment (including ventricular drainage in the preoperative, postoperative lumbar puncture or lumbar wear a catheter) and conservative treatment the therapeutic effect of poor-grade aneurysm patients.Methods:Analyzed119patients of WFNS (World Federation of Neurosurgical Societies) â…£ and â…¤ grade from June2004from to December2011, including73cases of WFNS IV grade,46of V grade. There were51males and68female, age range were32-77years, mean55.2years. All patients received neurosurgery intensive care, control blood pressure, nimodipine for anti-vasospasm therapy at admission. If necessary, external ventricle drainage was performed.57cases underwent surgical clipping (hematoma in surgery to clear the12cases,9cases of decompressive craniectomy,6cases of external ventricular drainage),40cases underwent interventional embolization (13cases of preoperative drainage),22cases received conservative treatment. Outcome was assessed at3months follow-up (range1months to12months) according to Glasgow outcome score (GOS).Results:In the WFNS â…£-â…¤ grade patients,22cases (38.6%) of a good prognosis (5-4points) in surgical clipping group; poor prognosis (3-2points) in30cases (52.6%); death (1points) in5cases (8.8%).26cases (65.0%) of a good prognosis (5-4 points) in interventional embolization group; poor prognosis (3-2points) in1cases (2.5%); death (1points) in13cases (32.5%). The prognosis of conservative treatment (5-4)0cases; poor prognosis (3-2points) in3cases (13.6%) and19cases (86.4%) died. Surgical clipping, interventional embolization and conservative treatment prognosis difference was statistically significant. Interventional embolism prognosis of good outcome than surgical clipping and conservative treatment (P<0.05), but higher mortality than surgical clipping (P<0.05).In conservative treatment group, mortality was significantly higher than the first two groups (P<0.05). For patients in WFNS â…£ grade, there were no differences in statistical significance for good result in the surgical clipping group and the embolization group (P<0.05), while the two groups of deaths results difference was statistically significant (P<0.05), mortality in embolization group was significantly higher than in surgical clipping group; conservative group, mortality was significantly higher than the previous two groups. For patients in WFNS â…¤ grade, the prognosis is good,poor and death result in surgical clipping group and intervention group were statistically significant (P<0.05), the latter result is better than the former, especially in severe disability and vegetable survival rate better than the former, but the mortality rate higher than the former. Mortality in conservative treatment group was100%.Conclusions:For patients of WFNS â…£ grade, surgical clipping and interventional embolization can be selected;For patients of WFNS â…¤ grade, interventional embolization can be used as the first choice; in the three treatment methods of choice, regardless of WFNS Grade â…£ or WFNS â…¤ grade, conservative treatment shows the worst prognosis (poor prognosis and death) and the highest mortality.Conservative treatment is not the first choice; when patients of WFNS â…£ or â…¤ grade with large intracerebral hematoma (hematoma volume>30mL), surgical clipping should be preferred. Removal of intracranial hematoma and the craniectomy pressure can achieved the better prognosis. Objective:To study compared the ultra-early treatment, early treatment, the medium-term treatment and late treatment on the prognosis of Poor-grade aneurysm patients.Methods:Analyzed119patients of WFNS (World Federation of Neurosurgical Societies)IV and V grade from June2004from to December2011, including73cases of WFNS IV grade,46of V grade. There were51males and68female, age range were32-78years, mean56.3years. All patients received neurosurgery intensive care, control blood pressure, nimodipine for anti-vasospasm therapy at admission. If necessary, external ventricle drainage was performed.57cases underwent surgical clipping, including2cases of ultra-early treatment,14cases of early treatment,28cases of the medium-term treatment and13cases of late treatment;40cases underwent interventional embolization,14cases of ultra-early treatment,16cases of early treatment,8cases of the medium-term treatment and2cases of late treatment,22cases received conservative treatment. Outcome was assessed at3months follow-up (range1months to12months) according to Glasgow outcome score (GOS).Results:In the WFNS grade IV-V grade patients, there were0.0%of a good prognosis (5-4points) in surgical clipping group who received ultra-early treatment.92.9%of good prognosis in interventional embolization group; poor prognosis were100%vs0.0%in two groups and death were0.0%vs7.1%respectively. Early treatment:good prognosis is35.7%vs81.2%; poor prognosis64.3%vs0.0%; death0.0%vs18.8%; Medium-term treatment:good prognosis is60.7%vs0.0%; poor prognosis35.7%vs0.0%; death3.6%vs100%; Late treatment:good prognosis is0.0%vs0.0%; poor prognosis69.2%vs50.0%; death30.8%vs50.0%. In the ultra-early and early treatment, Surgical clipping and interventional embolization prognosis (good and poor) difference was statistically significant(P<0.05). In the early treatment. In medium-term treatment, Surgical clipping and interventional embolization prognosis (good and poor) difference was statistically significant(P <0.05). In late treatment, Surgical clipping and interventional embolization prognosis (good,poor and death) difference was not statistically significant. The mortality rates of embolism higher than surgical clipping in four periods. For patients in WFNS â…£ grade, good prognosis is100%in ultra-early treatment; poor prognosis is0.0%; death is0.0%. There were70.6%,23.5%and5.9%in early treatment. In medium-term treatment was593%,37.0%and3.7%;0.0%.60.0%and40.0%in late treatment. There were statistically significant(P<0.05) of prognosis (good,poor and death) in four periods. For patients in WFNS â…¤ grade, good prognosis is57.1%in ultra-early treatment; poor prognosis is28.6%; death is14.3%. The early treatment was46.2%,38.5%and15.3%respectively. Medium-term treatment was11.1%.0.0%and88.9%. Late treatment was0.0%,80.0%and20.0%. Good prognosis was statistically significant (P<0.05) between Ultra-early. early treatment and medium-term. late treatment. Poor prognosis of late treatment was statistically significant (P<0.05)with other three periods. Death in the medium-term treatment results was statistically significant (P<0.05) with other three periods.death in the medium-term treatment results was higher than other three periods.Conclusions:For patients of WFNS â…£ grade, the treatment was performed as soon as possible. For patients in WFNS â…¤ grade, ultra-early and early treatment is better than medium-term and late treatment.Mortality of medium-term treatment was the highest. Overall prognosis of late treatment was the worst. In four different periods, regardless of WFNS â…£ grade or â…¤ grade, interventional embolization can be used as the first choice in ultra-early and early periods (excluding large intracerebral hematoma). Good prognosis results was higher than the interventional embolization in medium-term treatment of surgical clipping. The mortality rates of embolism higher than surgical clipping in four periods, but prognosis was not statistically significant. Regardless of treatment period, conservative treatment shows the worst prognosis (poor prognosis and death) and the highest mortality. Objective:The management of patients with poor-grade subarachnoid hemorrhage (SAH) continues to be controversial. The objective of this study was to examine predictors of outcome of poor-grade SAH after surgical obliteration of the aneurysm.Methods:The study was performed as a retrospective review of119patients of WFNS (World Federation of Neurosurgical Societies)â…£ and V grade from June2004from to December2011, including73cases of WFNS â…£ grade,46of â…¤ grade. There were51males and68female, age range were32-77years, mean55.2years. Outcome was assessed at3months follow-up (range1months to12months) according to Glasgow outcome score (GOS).Results:A favorable outcome at discharge was achieved in52of the119patients. Age (p<0.05), World Federation of Neurosurgical Societies (WFNS) grade â…¤ at admission (p<0.05), improvement in WFNS grade after admission (p<0.05), Fisher grade (p<0.05) and a low-density area (LDA) associated with vasospasm on computed tomography(p<0.05) showed a significant association with outcome. Further analysis of WFNS grades indicated that most patients who only improved to preoperative grade â…£ from grade â…¤ at admission did not have a favorable outcome. Multivariate analysis identified age (especially of> or=65years;p<0.01), WFNS grade â…¤ (p<0.01) and LDA associated with vasospasm on CT (p<0.01) as predictors of a poor outcome, and improvement in WFNS grade as a predictor of a favorable outcome after surgical obliteration of the aneurysm.Conclusions:Advanced age, WFNS grade â…¤, improvement in WFNS grade, and LDA associated with vasospasm on CT were found to be independent predictors of clinical outcome.
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