RISK SCORE ESTIMATION - A NEW METHOD TO DETERMINE OPTIMAL TIMING OF ANEURYSM CLIPPING FOR IMPROVED MANAGEMENT OUTCOME

The outcome of 703 patients who underwent surgery following aneurysmal subarachnoid hemorrhage were analyzed with regards to age, associated medical conditions, vasospasm and clinical status at the time of oper ation. Patients with Hunt and Hess grade I, II, and III had a 96%, 90% and 93% favorable (good and fair) outcome respectively In contrast on ly 58% of patients with grade IV had the same result. The outcome was unfavorable in 13% of the patients who were older than 60 years of age and only in 9% of the patients between 30-59 years of age. All the pa tients younger than 30 years old had a good outcome. Associated medica l condition increased the incidences of poor outcome (7% vs. 12%). Pat ients harboring vertebrobasilar aneurysms had a poorer outcome, as opp osed to those with aneurysms located in the anterior circulation (20% vs. 8%), The presence of angiographic vasospasm alone did not influenc e outcome. A proposed point value was given for each of the adverse fa ctors and from this the optimal surgical time was determined for each individual patient. This concept of Risk Score Estimation approach may improve the management outcome of patients with ruptured intracranial aneurysms.