• Kuntal Kanti Das, Suyash Singh, Pradeep Sharma, Anant Mehrotra, Kamlesh Bhaisora, Jayesh Sardhara, Arun K Srivastava, Awadesh K Jaiswal, Sanjay Behari, and Raj Kumar.
• Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Uttar Pradesh, India. Electronic address: kkdas@sgpgi.ac.in.
• World Neurosurg. 2017 Jun 1; 102: 561-570.

BackgroundThe outcome associated with the treatment of poor-grade aneurysmal subarachnoid hemorrhage is rather discouraging. Even then, some patients may survive; however, the long-term outcomes and the patterns of recovery of these survivors have not received much attention in the literature.MethodsA total of 85 patients (mean age 53.3 years, male/female = 34:51, 98 aneurysms) with post resuscitation Hunt and Hess grades 4 and 5 subarachnoid hemorrhage were studied. Modified Rankin Scale score was used to determine the functional outcome. Different factors were analyzed with uni- and multivariate models for their effect on the functional outcomes after surgery.ResultsA total of 23 patients died in the 30-day perioperative period, whereas 8 patients died at follow-up (n = 31, 36.5%). Nearly 35% and 51% of the survivors obtained favorable short- and long-term functional outcomes, respectively. The presence of a space-occupying hematoma (P = 0.014) and the functional status at discharge significantly affected the long-term functionality (P = 0.004) in our patients. The functional improvement was steady with time (the probability of good outcome at about 2 months of discharge was around 65%, about 55% at 1 year, and 40% at 2 years and then achieved a plateau). Marked improvement occurred in 11% survivors even after 18 months.ConclusionsIf operated at the earliest opportunity after admission, meaningful survival may be provided to a significant number of patients with poor-grade subarachnoid hemorrhage. The recovery process in the survivors is a dynamic process and considering the late improvements in some, it is advisable be follow them beyond the conventional end points.Copyright © 2017 Elsevier Inc. All rights reserved.

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