OBJECTIVE: Shout-term pretreatment of patients with subarachnoid hemorrhage
, but without hematomas causing mass effect, who presented in poor neurolog
ical condition at admission was evaluated as a protocol for the selection o
f candidates for radical surgery.
METHODS: One hundred-three patients were pretreated for 12 hours with contr
ol of blood pressure and intracranial pressure, using diuretic agents and/o
r ventricular drainage.
RESULTS: Neurological improvement was observed for 32 of 47 patients in Gra
de IV at admission and 23 of 56 patients in Grade V (P < 0.01). Hydrocephar
us requiring drainage was more common (P < 0.05) and the interval between o
nset and admission was shorter (P < 0.01) for the improved group. Clipping
surgery was performed for all patients in Grade III or better and for patie
nts in Grade IV who were less than 75 years of age and without systemic com
plications, i.e., 38 of 47 patients in Grade (V and 16 of 56 patients in Gr
ade V at admission. Good outcomes (defined as moderately disabled or better
on the Glasgow Outcome Scale) were achieved by 34 of 38 patients in Grade
IV and 10 of 16 patients in Grade V (P < 0.01). The proportion of patients
in Grade IV after pretreatment was lower for Grade IV (2 of 38 patients) th
an for Grade V (9 of 16 patients) (P < 0.00001). However, none of the 49 pa
tients who underwent nonsurgical treatment achieved good outcomes.
CONCLUSION: Our protocol may be beneficial for the selection of candidates
for radical surgery among patients with subarachnoid hemorrhage but without
hematomas who are in poor neurological condition at admission and for the
improvement of postoperative outcomes.