Surgical treatment of ruptured intracranial aneurysms: Timing of treatment and outcome

• Main Authors: Marcos Dellaretti, MD, PhD, Danilo Malta Batista, MD, Júlio César de Almeida, MD, Renata Ferreira de Souza, MD, Daniel Espíndola Ronconi, MD, Carlos Eduardo Romeu de Almeida, MD, Renato Rinco Fontoura, MD, Wilson Faglioni Júnior, MD
• Format: Article
• Language: English
• Published: Elsevier 2018-12-01
• Series: Interdisciplinary Neurosurgery
• Online Access: http://www.sciencedirect.com/science/article/pii/S2214751918301397

Background: Patients with ruptured intracranial aneurysm should be treated as early as possible, ideally in the first three days post-hemorrhage. However, in countries like Brazil, these patients are usually not admitted to hospital during this period, creating controversies about ideal timing for surgery. Objective: This study evaluated associations between the timing of treatment and the outcomes of patients submitted to clipping of ruptured intracranial aneurysms. Methods: A retrospective investigation about 218 patients, with 251 ruptured aneurysms, submitted to surgery for clipping was conducted. All patients were treated on the day of admission. Regarding the timing of treatment post-hemorrhage, patients were divided into early surgery, treatment on days 1 or 2; intermediate surgery, on days 3–10; and late surgery, >10 days. The grade of subarachnoid hemorrhage on admission was assessed by Hunt and Hess scale. Outcomes on discharge were investigated using the modified Rankin scale and mortality rate. Results: In 102 patients admitted with good clinical grade, 19 showed poor outcomes (mortality rate: 6.8%), while, in 86 patients admitted with poor clinical grade, 50 showed poor outcomes (mortality rate: 27.9%). No statistically significant relationships were verified between the timing of surgery and a poor outcome and mortality, even classifying patients according to aneurysm location and Hunt Hess scale. Conclusion: No statistically significant associations among mortality or poor outcome and timing for surgery were demonstrated. Considering the risks of re-bleeding and hospital stay, the surgical clipping should be considerate as soon as possible in patients with ruptured aneurysms. Keywords: Intracranial aneurysm, Mortality, Subarachnoid hemorrhage, Surgery, Time-to-treatment, Treatment outcome