Comparison of operative and endovascular treatment of anterior circulationaneurysms in patients in poor grades

We assessed the outcome of surgical and endovascular treatment in patients in poor (Hunt & Hess IV or V) grade following subarachnoid haemorrhage due to anterior circulation aneurysm (ACA). There were 41 patients, treated sur gically (20), by the endovascular route (20) or both (1). The aneurysms wer e clipped in 20 patients, wrapped in one; 19 were treated with Guglielmi de tachable coils (GDC), one by parent vessel occlusion using detachable ballo ons. One GDC treatment was interrupted and the aneurysm was surgically clip ped instead. We treated five patients surgically to evacuate accompanying i ntracerebral clots. We treated 14 (66 %) patients by the endovascular route and 15 (71 %) surgically within 72 It of the haemorrhage. The frequency of delayed ischaemic neurological deficit and/or cerebral infarct due to vaso spasm did not differ significantly between the endovascular and surgical gr oups. We had one surgical and three endovascular procedure-related complica tions with clinical manifestations. Outcome was evaluated after 6 months. A fter GDC treatment, angiographic follow-up was carried out between 8 and 26 months (mean 17 months). Good outcomes were achieved in six (29 %) of the surgically treated patients (40 % of the survivors) and six (30 %) of the e ndovascular treatment patients (60 % of the survivors). Outcome was similar after surgical and endovascular approaches. The decision as to which treat ment to chosen is influenced mainly by clinical factors such as cerebral ha ematoma or age.