J Korean Neurosurg Soc.  2001 Aug;30(8):1013-1018.

The Outcome of Urgent Surgery for Hunt-Hess Grade IV Patients with Ruptured Intracranial Aneurysm

• Oh JG
• Kang HI
• Moon BG
• Lee SJ
• Kim JJ

Abstract

OBJECTIVE
About 40% of patients who admit to the hospital after subarachnoid hemorrhage are poor clinical grade(Hunt-Hess grade IV, V). The majority of these patients have been excluded from early, aggressive treatment. The current study was undertaken to evaluate the outcome of urgent surgery for Hunt-Hess grade IV aneurysmal subarachnoid hemorrhage.
MATERIALS AND METHODS
We reviewed hospital records and radiographic studies of 36 patients who were Hunt-Hess grade IV among 201 cases with ruptured intracranial aneurysm admitted between Sep. 1995 and Dec. 2000. Operated patients were treated with urgent angiography and surgery within 24 hours of presentation, except six patients, and medical records of these patients were reviewed for the clinical course and Glasgow outcome scale(GOS).
RESULTS
Overall management results of the 36 patients were good recovery in 13(36.1%), moderate disability in 12 (33.3%), severe disability in 1(2.8%), vegetative state in 1(2.8%) and 9(25.0%) of surgically treated patients had died.
CONCLUSION
Although with limited number of patients, we conclude that urgent surgery for Hunt-Hess grade IV patients results in a better neurologic outcome and urgent surgery combined with aggressive postoperative management can minimize mortality.

Keyword

Hunt-Hess grade IV; Subarachnoid hemorrhage; Urgent surgery; Mortality

MeSH Terms

Angiography
Hospital Records
Humans
Intracranial Aneurysm*
Medical Records
Mortality
Persistent Vegetative State
Subarachnoid Hemorrhage