The impact of surgical timing on the management of aneurysms with acute hydrocephalus after aneurysmal subarachnoid hemorrhage

Abstract

AIM: To explore the feasibility and effectiveness of early microsurgical therapy for acute hydrocephalus resulting from a ruptured intracranial aneurysm. MATERIAL and METHODS: Forty patients with Hunt-Hess grades II-III were assigned to group A; 27 patients with grades IV-V formed group B. The patients were also divided into 2 groups based on the time interval between the hemorrhage and surgery. Subjects in the early surgery group underwent aneurysm clipping within 3 days of subarachnoid hemorrhage (SAH), followed by intraoperative lateral ventricle puncture and third ventriculostomy. Subjects in the late surgery group underwent aneurysm clipping within 10 days of SAH, after initial treatment with lateral ventricular drainage. Three months after surgery, we used the Glasgow Outcome Scale (GOS) to compare the differences between the early and late surgery groups. RESULTS: More patients benefited from early surgery than from late surgery in both groups: GOS4-5 was achieved by 75% and 73.3% of early-surgery patients compared to 37.5% and 25% of late-surgery patients from Groups A and B, respectively (both p <0.05). Analysis of the relationship between surgical timing and outcomes with the Ridit method showed that outcomes of early surgery were better than those of late surgery (p <0.05). CONCLUSION: Aneurysmal SAH with acute hydrocephalus requires early surgery.