Improved outcome after rupture of anterior circulation aneurysms: a retrospective 10-year review of 224 good-grade patients

Peter D. Le Roux Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington

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J. Paul Elliott Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington

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Lois Downey Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington

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David W. Newell Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington

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M. Sean Grady Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington

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Marc R. Mayberg Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington

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Joseph M. Eskridge Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington

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H. Richard Winn Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington

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Page Range:
394–402
Volume/Issue:
Volume 83: Issue 3
DOI link:
https://doi.org/10.3171/jns.1995.83.3.0394
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✓ Several significant diagnostic and therapeutic advances in the management of subarachnoid hemorrhage have emerged during the last 10 years. The present study was undertaken to determine whether these advances have improved overall outcome in patients of low surgical risk and what factors predict outcome. The authors retrospectively reviewed the management of good-grade patients seen at the Harborview Medical Center at the University of Washington, who suffered ruptured anterior circulation aneurysms between 1983 and 1993. The results in this series demonstrate that favorable outcomes occurred in 96.8% of patients designated Hunt and Hess Grade I, 88.3% of those assigned Grade II, and 81.3% of those deemed Grade III after rupture of anterior circulation aneurysms. On the basis of clinical and radiographic factors present at admission, correct prediction can be made about all favorable, but only 17% of unfavorable outcomes. During the decade under investigation, the authors observed a significant (p = 0.002) increase in the number of favorable outcomes: 74.5% of patients treated during the first management period (1983–1987); 87% of patients treated during the second period (1987–1990); and 93.5% of patients treated during the third management period (1990–1993) experienced favorable outcomes. Improvements in critical-care techniques and the management of vasospasm may be associated with the improved outcome observed during this series.

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Contributor Notes

Current address for Dr. Le Roux: New York University Medical Center, New York, New York.
Address reprint requests to: H. Richard Winn, M.D., Department of Neurological Surgery, University of Washington School of Medicine, 325 Ninth Avenue, ZA-86, Seattle, Washington 98104.
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