ANEURYSM SURGERY OF PATIENTS IN POOR GRADE CONDITION - INDICATIONS AND EXPERIENCE

Out of a total of 196 patients admitted with aneurysmal subarachnoid h aemorrhage (SAH) to the neurological department in Mainz over a 42 mon th period, 48 patients (24.5%) were considered as grade IV or V on adm ission. Aneurysm surgery within 48 hours after SAH was performed in 56 .3% of these patients, 2% were operated between day 3 and 7 and 16.6% were operated after day 7. 25% did not undergo operation because of se vere neurological deficit and brain damage. The overall outcome accord ing to the Glasgow outcome scale in the surgically treated group was f ull recovery in 11.1%, moderate disability in 16.7%, severe disability in 47.2%, vegetative state in 2.8% and death in 22.2%. All patients i n the not operated group died. Coed and moderate outcome was mainly se en in patients grade IV, which justify an aggressive strategy. Severe disability was mainly attributed to primary brain damage, while vasosp asm played a minor role. Impovement may only be achieved by early refe rral of SAH patients to neurosurgical centres.