Steiner H H, Kremer P, Kunze S
Neurochirurgische Klinik, Universität Heidelberg.
Zentralbl Neurochir. 1994;55(1):16-23.
The introduction of early aneurysm surgery in subarachnoid hemorrhage in the beginning of the eighties diminished the frequency of rebleeding. However, there are some objectives against early surgery due to its supposed higher morbidity. The present retrospective data elucidates the advantage of early aneurysmal surgery. In 1990 and 1991 we treated 175 patients with subarachnoid hemorrhage, of which 9 had no vascular malformation. In 166 patients a total of 190 aneurysmal malformations could be found. Of 60 patients with preoperative good clinical grades I and II (according to Hunt and Hess) 59 patients (99%) showed good or very good results classified by the Glasgow Outcome scale (GOS). Only one patient did not survive. Even in 61% of patients with poor grade aneurysms (III to V by Hunt and Hess) the outcome was good to very good; 15 patients (14%) survived with a distinct neurological deficit (grade 3 by GOS). Only one patient remained in a vegetative state. The total mortality of these 106 patients with grades III to V (Hunt and Hess) was 24%, among them 15 patients with preoperative grade V (Hunt and Hess). Overall it can be established, that there are no definite disadvantages of early aneurysmal surgery. The benefits of early surgery are a minimized risk of rebleeding, some effects of ameliorated conditions for intensive care treatment still have to be proven. Not only patients in good clinical condition (I and II by Hunt and Hess) show a good prognosis, even for patients with poor grade aneurysms (III to V by Hunt and Hess) a very good or at least good result can be achieved in 61%.
20世纪80年代初，早期动脉瘤手术被引入蛛网膜下腔出血的治疗，这降低了再出血的发生率。然而，由于早期手术被认为具有较高的发病率，因此也存在一些反对早期手术的观点。目前的回顾性数据阐明了早期动脉瘤手术的优势。1990年和1991年，我们治疗了175例蛛网膜下腔出血患者，其中9例没有血管畸形。在166例患者中，共发现190个动脉瘤畸形。60例术前临床分级为I级和II级（根据Hunt和Hess分级）的患者中，59例（99%）根据格拉斯哥预后量表（GOS）分类显示预后良好或非常好。只有1例患者死亡。即使在61%的动脉瘤分级较差（Hunt和Hess分级为III至V级）的患者中，预后也是良好至非常好；15例患者（14%）存活但有明显的神经功能缺损（GOS分级为3级）。只有1例患者处于植物人状态。这106例Hunt和Hess分级为III至V级的患者的总死亡率为24%，其中15例术前为V级（Hunt和Hess分级）。总体而言，可以确定早期动脉瘤手术没有明确的缺点。早期手术的好处是再出血风险降至最低，改善重症监护治疗条件的一些效果仍有待证实。不仅临床状况良好的患者（Hunt和Hess分级为I级和II级）预后良好，即使对于动脉瘤分级较差的患者（Hunt和Hess分级为III至V级），61%的患者也能取得非常好或至少良好的结果。
