• George Kwok Chu Wong, Ronald Boet, Stephanie Chi Ping Ng, Matthew Chan, Tony Gin, Benny Zee, and Wai Sang Poon.
• Division of Neurosurgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China. georgewong@surgery.cuhk.edu.hk
• World Neurosurg. 2012 Feb 1; 77 (2): 311315311-5.

BackgroundThe timing of definitive aneurysm treatment (coiling or clipping) in acute aneurysm subarachnoid hemorrhage was a subject of controversy. Although most vascular neurosurgeons agreed on early aneurysm treatment (within the first 72 hours), whether ultra-early aneurysm treatment (within the first 24 hours) was beneficial remained debatable. We aimed to investigate whether ultra-early aneurysm treatment is associated with better neurological outcome in all patients or only good-grade patients or only poor-grade patients.MethodsTwo-hundred and seventy-six (84%) patients had hemorrhage onset time and aneurysm treatment time available for analysis. Values of P < 0.05 were taken as statistically significant, and P values between 0.05 and 0.10 were considered to be a trend.ResultsFor the 96 poor-grade (World Federation of Neurological Surgeons grading scale 4 to 5) patients, there was a significant association between Short Form-36 mental scores and ultra-early aneurysm treatment (50 ± 10 vs. 46 ± 10, P = 0.019) and a trend toward association between ultra-early surgery and favorable neurological outcome (odds ratio 2.4 [95% confidence interval 1.0 to 6.0], P = 0.062). A reduction in clinical rebleeding (12% vs. 22%, P = 0.168) was observed in patients undergoing ultra-early aneurysm treatment.ConclusionsAneurysm treatment performed within the 24-hour window may be associated with a better outcome and halve the clinical rebleeding risk in poor-grade aneurysmal subarachnoid hemorrhage patients.Copyright © 2012 Elsevier Inc. All rights reserved.

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