Effect of early aneurysm surgery on prognosis: Calm down in a hurry!

INTRODUCTION: This study investigates effects of early surgery in aneurysmal subarachnoid hemorrhage (SAH) on outcome and postoperative complications.
METHODS: This retrospective study includes 250 patients presented to a teaching hospital with SAH and underwent aneurysm clipping during a 10-year period. 212 (84.8%) underwent early and 38 (15.2%) underwent late surgery. Presenting symptoms, clinical and neuroradiological findings, and outcomes were reviewed. Severity of SAH was assessed using World Federation of Neurosurgical Societies (WFNS) SAH scale and Fisher’s grading system. Glasgow Outcome Scale (GOS) was used for postoperative outcome measure.
RESULTS: Patients consisted of 142 (56.8%) female and 108 (43.2%) male with mean age of 52.5 years and female-to-male ratio of 1.3. Most common presenting symptoms were headache and vomiting (n=164; 65.6%). The incidence of SAH was highest in fall and spring, respectively. Patients fell under grade 1 on WFNS scale and grade 2 on Fisher’s scale. Significant correlation was found between WFNS and Fisher’s grades and GOS. Majority of patients underwent early aneurysm surgery and re-bleeding occurred in 4.3%. Mortality was 10.3% and vasospasm-related morbidity and mortality occurred in 6% and 6.8% of the patients, respectively. 84.8% of patients had favorable outcomes and 15.2% of patients had poor outcomes.
DISCUSSION AND CONCLUSION: Results showed that early surgery led to reduced morbidity and mortality. Patients admitted with SAH should be promptly evaluated and undergo angiography. Subsequently, the aneurysm should be promptly excluded from circulation to prevent rebleeding thus enabling the team to concentrate on managing other complications.