Abstract
In a consecutive series of 207 patients, who were operated on for the ruptured anterior circulation aneurysm in acute stage, 90 patients (43%) of Hunt and Kosnik (H-K) grade III were analyzed to evaluate the grading and to clarify the surgical indication. Those were divided into 3 groups: group A, 54 patients of 59 years or less of age; group B, 22 of 60-69 years; and group C, 14 of 70 years or more. The Glasgow coma scale (GCS) was adopted to assess the preoperative level of consciousness. The outcome was evaluated by the Glasgow outcome scale.
The rate of good recovery was 55% in 44 patients of GCS 13 and 85% in 20 of GCS 14. This difference was statistically significant (ρ<0.02). One-third of the patients, who were of GCS 11, had recovered well in group A, whereas none of GCS 12 recovered in group C. The outcome was significantly poor in the patients with preoperative arterial hypertension (systolic pressure ≥ 160mmHg), and in the patients with subarachnoid thick clot on CT in group A. The incidence of systemic complications was significantly high (ρ<0.05) in group C.
These results indicated that the outcome significantly differs between patients of GCS 13 and 14, and that the aged patients (≥ 70 years) had a poorer outcome despite the same GCS. It is stressed that the GCS score and the age are important prognostic factors in H-K grade III, and that the aged, whose GCS score is 12 or less, would not be indicated for surgery in the acute stage.
