The results of the treatment of one hundred and twenty SAH patients (63 females, 57 males) with a mean age 50.6±7 years were prospectively evaluated. SAH was detected on cerebral CT in 95% of the cases. The patients were divided into two therapeutic groups. Among our SAH patients, 62.5% with mean age of 52.4±5 received medical treatment and 37.5% with mean age of 49.7±3 were subjected to surgery.
Hypertension, smoking, oral contraceptive medication, past trauma and over dosage of oral anticoagulation therapy were found in 41.6%, 19.1%, 0%, 0%, and 0.8% of patients respectively. Fifty six patients were subjected to surgery, of whom 45 underwent craniotomy and aneurysmal clipping, while 11 cases had CSF shunting without aneurysmal clipping and were included into the medically managed group. Overall mortality was 44.2% of all SAH patients (60.4% of females and 39.6% of males). There was no statistically significant difference in the death rate between the two therapeutic groups (χ2=1.54, df=1, P=0.11) and no significant difference between the females and males (χ2=0.73, df=1, P=0.39).
The mean SAH onset to admission time in whole of our SAH patients and in their medical and surgical groups were 66±4, 84±1 and 24±7 hours respectively. The overall mean timing from the onset of SAH to death was 14.1±2 days. In the surgical group, the mean length of time from onset of SAH to surgery was 8.4±3 days and of those who died, the mean length of the time between surgery and death was 5.9±3 days.
compares the characteristics between surgical and medical groups. The effect of therapeutic type of aneurysm management on mortality was not significant (χ2=0.16, P=0.77). Rebleeding occurred in 4.4% of patients in the surgical group and 4% in the medical group and the difference was not statistically significant (χ2=0.014, P=0.91). Among 5 SAH patients with rebleeding, 2 had an anterior communicating artery aneurysm and 3 had a “normal angiography”. The influence of rebleeding on the overall mortality was not statistically significant (χ2=2.54, P=0.14). None of the studied patients had rebleeding before admission to hospital. However rebleeding may have occurred in patients who died before arriving to the hospital and these were not included in this study. Hydrocephalus was found in 17 patients and its frequency was not significantly different in the two therapeutic groups (χ2=5.58, P=0.03).
Clinical characteristics of surgical and medical groups of our SAH patients
Out of 17 SAH patients with hydrocephalus, 13 (76%) died and the effect of hydrocephalus on the mortality of these patients was significant (χ2=7.93, P=0.007). Cerebral infarction due to vasospasm occurred in 7 (5.8%) patients (4.4% of the surgical and 6.7% of the medical group).
The choice of aneurysmal therapeutic strategy on frequency of cerebral infarction was not significant (χ2=0.25, P=0.71). Out of seven patients with brain infarction due to vasospasm, three cases died. The effect of cerebral infarction on the overall mortality of SAH patients was not significant (χ2=0.005, P=1).
represents distribution of complications in two therapeutic groups of our patients. Aneurysms were found in the angiography of 62 patients (45 in the surgical and 17 in the medical group). The distribution was as follows: Anterior communicating artery 41.9%, middle cerebral artery 23.1%, internal carotid artery 14.5%, basilar artery 4.8%, anterior cerebral artery 4.8%, posterior communicating artery 6.4%, and multiple aneurysms 3%. Among 62 SAH patients with aneurysm on angiography, 45 patients (72.6%) underwent aneurysm surgery and 17 cases (27.4%) received only medical management. Death was recorded in 48.9% of SAH patients with aneurysm who underwent aneurysm surgery (22/45) and 41.2% of patients with aneurysm who only received medical management (7/17).
Distribution of complications and outcome in two therapeutic groups of our SAH patients
High Hunt and Hess scale, poor general medical condition and refusal of patients constituted reason of excluding these 17 cases with aneurysm from surgical group in 58.8%, 29.4% and 11.7% respectively. Details of Hunt and Hess scales of these seventeen cases are presented in . The difference in the mortality rate in 62 SAH patients with angiographically confirmed aneurysms in two therapeutic groups was not statistically significant (χ2=0.16, P=0.77).