Early surgery of patients grade IV or V after Hunt and Hess

Abstract

Also at present, early surgery (within 72 hours) of ruptured aneurysms is not acknowledged without limitations by all neurosurgeons, although conservative treatment of patients initially in a bad clinical state (Hunt and Hess grade IV or V) exacts an additional unfavorable influence on morbidity and mortality in this patients group. A number of studies found a mortality of nearly 100% in the conservatively treated group of patients in an initial state corresponding to a Hunt and Hess grading of IV or V. These results led to the conclusion that, regarded in retrospect, approximately half of these patients could possibly have profited from early surgery, because they had died without early surgery of rebleeding or vasospasm (Bailes et al., 1990; Seifert, Trost and Stolke, 1990).