Stroke, Vol 24, 1649-1654, Copyright © 1993 by American Heart Association
R Fogelholm, J Hernesniemi and M Vapalahti
BACKGROUND AND PURPOSE: Population-based patient materials have not been
used earlier in assessing the effects of neurosurgical treatment on
survival and functional outcome of subarachnoid hemorrhage. Moreover, the
proportion of all subarachnoid hemorrhage patients who might be candidates
for neurosurgical treatment has not been estimated. METHODS: We compared
the survival and functional outcome of two population-based patient
materials from Central Finland in 1976 through 1978 (n = 146) and 1980
through 1987 (n = 351). The most important basic characteristics of both
materials were similar. In the 1970s, only patients aged < 60 years with
carotid territory aneurysms were operated on after an interval of 2 weeks
from the bleeding. In the 1980s, early surgery was attempted, and the other
exclusion criteria were abandoned. Allocation to medical or surgical
treatment was not randomized. RESULTS: During the 1970s, only 14% of the
patients had surgical treatment, with a median delay of 15 days after the
bleeding; in the 1980s, the corresponding figures were 46% and 4 days.
Despite these fundamental changes in the treatment policy, the survival up
to 3 years in the 1980s was only marginally improved compared with the
1970s. Conversely, the functional outcome at 4 years after the bleeding was
significantly better in the 1980s than the 1970s, with 82% and 64% of the
survivors, respectively, being independent in the activities of daily
living (P = .002). We estimated that 60% of all patients with subarachnoid
hemorrhage might be candidates for neurosurgical treatment, provided that
there are no delays in admission or evaluation. CONCLUSIONS: An active
treatment policy of subarachnoid hemorrhage including early surgery only
marginally improves survival, but the quality of life of the survivors is
significantly better. Only 60% of all patients in the population with
subarachnoid hemorrhage can, at least theoretically, benefit from surgical
treatment.
ARTICLES
Impact of early surgery on outcome after aneurysmal subarachnoid hemorrhage. A population-based study
Department of Neurology, Central Hospital of Central Finland, Jyvaskyla.
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