THERAPEUTIC MANAGEMENT OF GRADE-IV ANEURYSM PATIENTS

BACKGROUND The timing of surgery in patients suffering from subarachno id hemorrhage grade IV and V according to Hunt and Hess, is still cont roversial. Several authors advocate early surgery for patients in poor clinical condition. Improved outcome and decreased mortality rates we re reported. Others exclude patients in poor condition from early aneu rysm surgery. METHODS Forty grade IV aneurysm patients were admitted t o our department. After ventriculostomy and cerebral angiography, 28 o f them were operated on within 72 hours. The postoperative treatment i ncluded hypertensive, hypervolemic, hemodilutional therapy (triple-H t herapy) and intensive monitoring (intracerebral pressure, blood pressu re, hemodynamic parameters). The mean follow-up time was 6 months. RES ULTS Out of the 28 patients who underwent early surgery, 64% were in g ood health, 11% in poor health, 25% died; there were no survivors in a vegetative state. Twelve patients were treated conservatively; 50% di ed from infarction and rebleeding, before the operation was performed. Six underwent delayed aneurysm surgery after clinical improvement. In this group, 25% had good clinical outcome. CONCLUSIONS Our results fa vor an aggressive treatment of grade IV aneurysm patients by means of ventricular drainage, early surgery and triple-H therapy. (C) 1997 by Elsevier Science Inc.