IMPROVED OUTCOME AFTER RUPTURE OF ANTERIOR CIRCULATION ANEURYSMS - A RETROSPECTIVE 10-YEAR REVIEW OF 224 GOOD-GRADE PATIENTS

Several significant diagnostic and therapeutic advances in the managem ent of subarachnoid hemorrhage have emerged during the last 10 years. The present study was undertaken to determine whether these advances h ave improved overall outcome in patients of low surgical risk and what factors predict outcome. The authors retrospectively reviewed the man agement of good-grade patients seen at the Harborview Medical Center a t the University of Washington, who suffered ruptured anterior circula tion aneurysms between 1983 and 1993. The results in this series demon strate that favorable outcomes occurred in 96.8% of patients designate d Hunt and Hess Grade I, 88.3% of those assigned Grade II, and 81.3% o f those deemed Grade III after rupture of anterior circulation aneurys ms. On the basis of clinical and radiographic factors present at admis sion, correct prediction can be made about all favorable, but only 17% of unfavorable outcomes. During the decade under investigation, the a uthors observed a significant (p = 0.002) increase in the number of fa vorable outcomes: 74.5% of patients treated during the first managemen t period (1983-1987); 87% of patients treated during the second period (1987-1990); and 93.5% of patients treated during the third managemen t period (1990-1993) experienced favorable outcomes. Improvements in c ritical-care techniques and the management of vasospasm may be associa ted with the improved outcome observed during this series.