Abstract
We retrospectively analyzed 315 patients with aneurysmal subarachnoid hemorrhage (SAH) treated with direct clipping surgery. Their ages ranged from 19 to 89 (mean±SD: 61.0±13.1) years. The preoperative grade was evaluated by WFNS grade, with 112 patients were in grade I, 80 in grade II or III, 72 in grade IV, and 51 in grade V. We surgically treated all patients whose preoperative Glasgow Coma Scale (GCS) score was ≥6. In the patients whose GCS score was <6, patients who exhibited improvement in neurological symptoms were selected as candidates for direct surgery. We conducted clipping surgery in the acute stage to avoid further bleeding. We then surgically removed the subarachnoid clot and any intracerebral or intraventricular hematoma. Surgical outcome of patients was evaluated using the Glasgow Outcome Score (GOS) 3 months after onset. Rebleeding after surgery occurred in only 1 patient (0.3%). The percentage of patients achieving a favorable outcome (good recovery or moderately disabled) was 98% in grade I, 84% in grade II or III, 61% in grade IV, and 18% in grade V. The main factor responsible for an unfavorable outcome was cerebral vasospasm in grade II or III and initial brain damage in grade IV and V. The incidence of surgical complications related to a less favorable outcome was 2.9%. Patients over 80 years of age had a less favorable outcome than those younger than 80 (p<0.05). In conclusion, direct surgery is safe and secure for patients with aneurysmal SAH in WFNS grade I. Outcomes from direct clipping surgery was not always satisfactory, however, in patients with a poor WFNS grade or who were too elderly. A combination of intravascular treatment with novel treatment strategies may improve overall outcome in patients with aneurysmal subarachnoid hemorrhage.
