Management Outcome and Timing of Operation for Ruptured Vertebrobasilar Aneurysms

Abstract

We present a series of 100 patients with subarachnoid hemorrhage (SAH) due to ruptured aneurysms of the vertebrobasilar circulation, which were treated at University Hospital of Kumamoto and its 17 affiliated hospitals during a recent 5-year period. Ninety-five patients were admitted to the hospitals within Day 3 (day of SAH=Day 0). Seventy-six patients had surgery; 28 within the first week after SAH (early surgery group) and 48 after Day 8 (late surgery group). Management outcome at 6 months after SAH was significantly correlated with clinical grade (Hunt and Hess) on admission (p<0.0001). The overall mortality rate was 28%. Sixty-one patients were functioning independently (good), and 11 patients patients were significantly disabled (poor).
Twenty-one (64%) of 33 elderly patients above 65 years old had unfavorable (poor or dead) outcome. Nineteen (79%) of 24 patients without surgery for aneurysm (no surgery group) had unfavorable outcome. Of 46 patients with basilar aneurysms, 6 patients (50%) in the early surgery group had favorable outcome, compared to 17 patients (85%) in the late surgery group and only 2 patients (14%) in the no surgery group. All three elderly patients and 3 of 4 poor grade (Grade 3 or 4) patients who underwent early sugery for basilar aneurysm had unfavorable outcome. Of 26 patients with vertebral saccular aneurysms at the origin of posterior inferior cerebellar artery, 8 patients (80%) in the early surgery group and 8 patients (67%) in the late surgery group had favorable outcome, whereas all 4 patients in the no surgery group died due to rebleeding or angiospasm.
We recommend early surgery for patients with vertebral saccular aneurysm. However, early surgery for patients with basilar aneurysm should be performed only in cases with good preoperative grade (Grade for 2) and non-elderly patients.