TITLE:
Aneurysm Clipping and Outcome for Hunt & Hess Grade 4, 5 Subarachnoid Hemorrhage—A Literature Review
AUTHORS:
Kalyan Bikram Shah, Lukui Chen, Li Bing Qian, Sudeep Shrestha, Sandip Kumar Jaiswal
KEYWORDS:
Aneurysm, Subarachnoid Hemorrhage, Hunt & Hess Grading, Clipping, Outcome
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.8 No.2,
April
12,
2018
ABSTRACT: “Subarachnoid Hemorrhage is non-traumatic nasty bleeding
into the subarachnoid area, the territory between the arachnoid and the piamater
of the central nervous system showing prompt developing signs of neurological sequelae”.
It is one among the neurological emergencies which is a very distressing cerebrovascular
disease with complicated mechanisms that risks brain perfusion and its function,
having higher morbidity and mortality rates. Its mortality
rate is still ranged between 8.3% and 66.7%, with noticeable regional variations,
beside recent advances in treatment approaches. The incidence
of SAH among the population of 2 - 22.5/100,000
was reported with a minimum of 60% of aneurysm ruptures occurring amid ages of 40
and 60 years with 3:2 male:female ratio. The rupture
risks for unruptured aneurysms are increased by the issues like present smokers,
larger size of aneurysm, and amid young population. The surgical treatment decision
should be contemplated upon factors such as aneurysm’s size, aneurysm’s location,
patient’s illness history, and surgeon’s operative experiences. Latest technical progresses in imaging
techniques, increased consideration of illness history, more awareness
of incidences of aneurysms and use of micro
neurosurgery, have raised the chance for detection of subarachnoid hemorrhage (SAH)
and possible better outcomes with surgical management. Factors that
may affect outcome include age, size and site of aneurysm, interval between ictus
and surgery, CT Fisher Grade & Hunt and Hess
Grading earlier to surgery, & Glasgow Coma Scale at the while of discharge. The studies
here support the wide spread concept that surgical clipping of SAH for Hunt and Hess Grade 4, 5 SAH, which
is also considered as poor Grade SAH stipulates an effective treatment if done earlier provides better outcome.