The Management Of Ruptured Intracranial Anterior Circulation Aneurysms During The Intermediate Period

Objective To compare the effect of microsurgery for ruptured intracranial anterior circulation aneurysms during intermediate period versus delayed period and to evaluate the feasibility and safety of surgical clipping during intermediate period.In order to provide theoretical evidence for timing of clinical treatment of ruptured intracranial anterior circulation aneurysms.Methods A retrospective analysis of 95 patients with Hunt-Hess Gradeâ… -â…¢on admission who were admitted 4 to 10 days after initial supratentorial aneurysmal subarachnoid haemorrhage.Forty-one patients underwent intermediate clipping while 54 patients accepted delayed obliteration of ruptured aneurysm(days 11-30).Outcome after 6 months was assessed using Modified Rankin Scale(mRS).Correlation is analyzed between Hunt-Hess Grade before and mRS after the treatment.Unveil the factor of worse prognosis.Results There was no difference in outcome between two groups according to Modified Rankin Scale at 6 months follow-up.Thirty patients(73.2%) in the intermediate group and 42 patients(77.8%) in the late group had a favorable functional outcome with a mRS score of 0 to 2.Rebleeding before active treatment was the leading factor contributing to poor outcome.Conclusions Ruptured intracranial anterior circulation aneurysms during intermediate period should not be the reason for conservative treatment.So we suggest that active treatment should be taken in ruptured intracranial anterior circulation aneurysms during intermediate to avoid unfavourable consequence due to rebleeding.Whether conservative treatment should be taken in those who are in worse clinical condition and high Hunt-Hess Grade needs more data to prove.