Ultra-early (within 24 hours) aneurysm treatment after subarachnoid hemorrhage

World Neurosurg. 2012 Feb;77(2):311-5. doi: 10.1016/j.wneu.2011.09.025. Epub 2011 Nov 1.


Background: The timing of definitive aneurysm treatment (coiling or clipping) in acute aneurysm subarachnoid hemorrhage was a subject of controversy. Although most vascular neurosurgeons agreed on early aneurysm treatment (within the first 72 hours), whether ultra-early aneurysm treatment (within the first 24 hours) was beneficial remained debatable. We aimed to investigate whether ultra-early aneurysm treatment is associated with better neurological outcome in all patients or only good-grade patients or only poor-grade patients.

Methods: Two-hundred and seventy-six (84%) patients had hemorrhage onset time and aneurysm treatment time available for analysis. Values of P < 0.05 were taken as statistically significant, and P values between 0.05 and 0.10 were considered to be a trend.

Results: For the 96 poor-grade (World Federation of Neurological Surgeons grading scale 4 to 5) patients, there was a significant association between Short Form-36 mental scores and ultra-early aneurysm treatment (50 ± 10 vs. 46 ± 10, P = 0.019) and a trend toward association between ultra-early surgery and favorable neurological outcome (odds ratio 2.4 [95% confidence interval 1.0 to 6.0], P = 0.062). A reduction in clinical rebleeding (12% vs. 22%, P = 0.168) was observed in patients undergoing ultra-early aneurysm treatment.

Conclusions: Aneurysm treatment performed within the 24-hour window may be associated with a better outcome and halve the clinical rebleeding risk in poor-grade aneurysmal subarachnoid hemorrhage patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aneurysm, Ruptured / surgery
  • Cerebral Angiography
  • Confidence Intervals
  • Female
  • Humans
  • Hypertension / complications
  • Intracranial Aneurysm / surgery*
  • Male
  • Middle Aged
  • Neuropsychological Tests
  • Neurosurgical Procedures*
  • Odds Ratio
  • Prognosis
  • Prospective Studies
  • Recurrence
  • Subarachnoid Hemorrhage / surgery*
  • Surgical Instruments
  • Treatment Outcome