早期显微手术夹闭瘤颈治疗脑动脉瘤破裂出血

目的 探讨早期显微手术夹闭瘤颈治疗脑动脉瘤破裂出血的方法及临床效果。方法 应用显微手术治疗脑动脉瘤破裂出血早期病例92例，其中出血后24h内手术47例，24～48h内手术32例，48～72h内手术13例。术前病情分级（按照Hunt-Hess分级）Ⅰ级7例，Ⅱ级18例，Ⅲ级42例，Ⅳ级23例，Ⅳ级2例。92例患者共有110个动脉瘤，其中前交通动脉瘤48个，颈内动脉-后交通动脉瘤32个，大脑中动脉瘤18个，大脑前动脉瘤12个。对患者出院时的治疗效果进行GOS评分。结果 术后恢复良好71例，预后差14例，死亡7例。结论 早期应用显微手术治疗脑动脉瘤出血病人可以获得较满意的临床效果。     

126例颅内动脉瘤破裂的早期显微外科治疗

目的探讨早期显微外科手术治疗颅内动脉瘤破裂的疗效。方法126例颅内动脉瘤破裂患者根据Hunt—Hess分级，Ⅰ级20例、Ⅱ级37例、Ⅲ级42例、Ⅳ级18例、Ⅴ级9例。126例患者第一次手术均在出血后72h内，13例颅内多发动脉瘤患者进行了二次手术，所有患者术后用格拉斯哥评分表（GOS）随访1—3年。结果恢复良好98例；中度病残，但生活自理18例；重度病残，生活不能自理4例；植物生存1例；死亡5例。结论早期显微外科手术是治疗颅内动脉瘤破裂的有效方法，能改善动脉瘤患者的生存质量。     

显微手术治疗破裂颅内动脉瘤155例

目的 通过总结颅内动脉瘤破裂的显微手术治疗,探讨颅内动脉瘤破裂的手术时机、手术技巧对术后疗效的影响.方法 系统总结2004年10月至2007年10月经手术治疗的155例破裂颅内动脉瘤的临床情况,以GOS计分评价患者出院时转归,比较不同手术时机对预后的影响.结果 155例中发现162个动脉瘤,单纯夹闭149个,夹闭加包裹4个,包裹6个.手术时间在发病72 h之内(包括72 h)79例,3～14 d(包括14 d)65例,14 d以上11例.术后恢复良好140例(90.3%),一般11例(7.1%),植物生存3例(1.94%),死亡1例(0.65%).不同手术时期患者出院时GOS评分差异无统计学意义(P＞0.05).结论 显微手术治疗破裂的颅内动脉瘤可取得满意疗效.     

前循环动脉瘤破裂并发颅内血肿的超早期显微手术治疗

目的探讨前循环动脉瘤破裂并发颅内血肿的超早期显微手术治疗。方法回顾性分析20例前循环动脉瘤破裂并发颅内血肿患者的临床资料,所有病例术前急诊行脑血管3D-CTA检查,在24小时内行显微外科动脉瘤夹闭手术。结果 20例患者共发现20个破裂动脉瘤,3个未破裂动脉瘤,破裂动脉瘤中前交通动脉瘤6个,颈内后交通动脉瘤8个,大脑中动脉瘤6个,未破裂动脉瘤中颈内后交通动脉瘤1个,脉络膜前动脉瘤1个,前交通动脉瘤1个,直接夹闭破裂动脉瘤和2个未破裂动脉瘤。术后GOS分级5分8例,4分2例,3分3例,2分4例,1分3例。结论前循环动脉瘤破裂并发颅内血肿病情发展迅速,3D-CTA应作为该类患者术前首选检查手段,超早期显微手术清除血肿夹闭动脉瘤能取得较好的效果。     

血管内栓塞治疗基底动脉顶端动脉瘤

目的评价血管内栓塞治疗基底动脉顶端动脉瘤的疗效。方法回顾性分析2000年7月～2010年12月血管内栓塞治疗17例基底动脉顶端动脉瘤的临床资料。6例在出血2天内1、1例在出血3～10天内进行血管内栓塞治疗。应用Neuroform支架辅助弹簧圈栓塞宽颈动脉瘤3例,弹簧圈栓塞14例。结果 17例中成功栓塞16例,其中10例100%栓塞,3例95%栓塞,3例90%栓塞,术中动脉瘤破裂1例（弹簧圈栓塞,次日死亡）。出院时格拉斯哥预后评分（GOS）,恢复良好12例;中度病残,但生活能自理3例;重度病残,生活不能自理1例。16例随访6～36个月,平均15个月,无术后再出血,2例复发。结论血管内栓塞是治疗基底动脉顶端动脉瘤的一种微创、相对安全有效的治疗方法。     

显微手术中亚低温对颅内破裂动脉瘤预后的影响

目的 观察颅内破裂动脉瘤行显微手术夹闭过程中应用亚低温处理对预后的影响.方法 回顾性对比分析2006年9月-2010年12月颅内破裂动脉瘤施行显微手术40例的临床资料,其中亚低温处理20例,常温处理20例.亚低温处理于麻醉诱导后开始,在打开硬脑膜前达到中心体温33℃～35℃,并持续至关闭硬脑膜后复温.常温处理除了不进行亚低温治疗外其余治疗方法与亚低温相同.观察记录患者术后1周内颅内血肿、颅内水肿、症状性脑血管痉挛、心衰、肺部感染、上消化道出血等并发症发生率、术后1周及随访3个月的GOS评分.结果 术后1周内复查头颅CT:常温处理组出现术后再出血1例,脑水肿2例,症状性脑血管痉挛9例,其中肺部感染2例,平均住院时间为(26.10±11.09)d.亚低温处理组出现脑水肿1例,症状性脑血管痉挛3例,其中肺部感染2例,平均住院时间为( 18.85±10.84)d.根据GOS评分:术后1周时预后良好率常温处理的为65.0％,亚低温处理的为90.0％;术后随访3个月,常温处理的预后良好率为85％,亚低温处理的为95％.结论 术中33℃～35℃亚低温处理可显著改善颅内破裂动脉瘤显微手术后1周的GOS预后评分,治疗效果较好.     

颅内前循环动脉瘤的显微外科手术治疗

目的 探讨颅内前循环动脉瘤显微外科手术治疗方法,总结前循环动脉瘤治疗的相关经验.方法 回顾性分析近2年来显微外科治疗Ⅰ～Ⅳ级颅内前循环动脉瘤171例(共174个动脉瘤)的临床资料,以及不同部位动脉瘤的手术技巧及治疗经验.结果 Ⅰ～Ⅳ级颅内前循环动脉瘤171例,其中后交通动脉瘤67例,前交通动脉瘤56例,大脑中动脉瘤32例,颈内动脉分叉部动脉瘤10例,眼动脉瘤6例,多发动脉瘤3例.均成功进行了手术夹闭,术后GOS评分预后分级Ⅰ级3例,Ⅲ级6例,Ⅳ级14例,Ⅴ级148例.结论 良好的显露及显微外科技术是成功夹闭动脉瘤的关键;术中预判、动脉瘤夹合理的选择、载瘤动脉的正确阻断是值得重视的影响手术成败的因素.     

显微手术治疗破裂前循环脑动脉瘤的临床研究

目的临床研究显微夹闭手术在治疗破裂的脑前循环动脉瘤中的疗效,总结手术经验。方法回顾分析42例破裂脑前循环动脉瘤的显微手术治疗临床资料,结合随访结果,进行相关因素分析。结果本组动脉瘤均得到满意夹闭。手术后3例死亡。生存病例全部在出院后3~6月进行门诊或电话随访。患者神经功能以改良的Rankin量表(mRS)评价,疗效良好:mRS 0~3分29例,疗效差:mRS 4~6分13例。结论破裂的前循环脑动脉瘤早期行显微夹闭手术可取得较好疗效。年龄、术前Hunt-Hess分级、有脑疝和呼吸改变、CT Fisher分级与预后近期预后相关。     

未破裂颅内动脉瘤72例临床分析

目的 探讨未破裂颅内动脉瘤的处理方式及其疗效,以指导临床治疗.方法 回顾性分析我科收治的72例未破裂颅内动脉瘤的患者,所有患者均行DSA或CTA明确诊断,采用血管内栓塞治疗、开颅手术夹闭或者观察三种治疗策略,对比分析其疗效.结果 血管内栓塞治疗15例,手术夹闭40例.出院时GOS评分5分血管内介入治疗组14例（93.3%）,开颅手术夹闭组31例（77.5%）.两组患者治疗后出院前行GOS评分经卡方检验无明显差异（P＆gt;0.05）.观察随诊处理17例,无变化15例,再出血2例.结论 根据未破裂动脉瘤的特点、患者自身状况及要求、就诊中心诊疗技术等决定未破裂动脉瘤的治疗方式,个体化治疗是最佳的治疗方案.     

不同Hunt-Hess分级及手术时机对血管内介入栓塞治疗脑动脉瘤破裂患者预后效果的影响

目的分析不同Hunt-Hess分级及手术时机对血管内介入栓塞治疗脑动脉瘤破裂患者预后效果的影响。方法选取2013-01—2019-01间西平县人民医院收治的69例Hunt-HessⅠ～Ⅳ级脑动脉瘤破裂患者,分别于发病后第1、2、3天实施血管内介入栓塞。回顾性分析其临床资料。结果随访6个月,末次随访,依据GOS预后评分标准,Hunt-HessⅠ、Ⅱ、Ⅲ、Ⅳ级患者的预后良好率分别为95.7%、93.1%、81.8%和50.0%;发病后第1、2、3天施术患者的预后良好率分别为95.7%、91.3%和78.3%。无死亡病例。结论血管内介入栓塞是治疗脑动脉瘤破裂患者的有效术式。尽早对Hunt-HessⅠ～Ⅲ级患者实施手术,有利于提升预后效果。     

Ruptured anterior communicating artery aneurysm. Therapeutic options in 119 consecutive cases

BACKGROUND AND PURPOSE: The respective roles of endovascular and surgical treatment must be clearly defined in the management of ruptured anterior communicating artery (AcoA) aneurysm. The aim of our study was to report our results, using the aneurysm direction as the main morphological argument to choose between microsurgery and endovascular embolization. Morbidity and mortality, causes of unfavorable outcome and morphological results were also assessed. PATIENTS AND METHODS: Our prospective study included 119 patients: 89 treated by microsurgery and 30 undergoing embolization with Guglielmi Detachable Coils (GDC). When the aneurysm had an anterior direction (fundus of the aneurysm in front of the pericallosal arteries), we attempted microsurgery. If the fundus of the aneurysm was behind the pericallosal arteries, we selected the most adapted procedure after discussion with the neurovascular team, taking into account the physiological status, treatment risk and neck size. Preoperative status of the patients was assessed according to the Hunt and Hess (HH) classification. Cerebral CT-scan and angiograms were routinely performed after treatment to determine causes of unfavorable outcome (GOS>1) and the morphological results. RESULT: Overall clinical outcome was excellent (GOS1) for 63.0% of patients, good (GOS2) for 10.1%, fair (GOS3) for 13.4%, poor (GOS4) for 2.5%. The mortality rate was 10.9%. Among the 82 patients in good preoperative grade (HHIII), 8 (21.6%) achieved an excellent outcome. However permanent morbidity or death occurred in 15 patients (78.4%). Permanent disability and death were related to initial subarachnoid hemorrhage and were observed 21.3% of patients in the microsurgical group and 30.0% in the endovascular group [Fisher's Exact Test; p=0.33]. Procedure-related permanent disability and death rates were 9.0% for the microsurgical group and 23.3% for the endovascular group (p=0.06) respectively. In the microsurgical group, the only morphologic characteristic which significantly correlated with the occurrence of vessel occlusion was the fundus direction (p=0.03). The difference between endovascular and microsurgical procedures in the achievement of complete occlusion was considered significant (p=0.04). CONCLUSION: In our experience, the direction of the aneurysm was the main morphological criterion in choosing between microsurgery or endovascular procedure for the treatment of AcoA aneurysm. We propose that microsurgical clipping should be preferred for AcoA aneurysms with anterior direction, and depending on morphological criteria, endovascular packing for those with posterior direction.     

The value of a computer tomography scanner and controlled arteriography in the study of the results of aneurysm surgery. A series of 100 consecutive cases

A total of 100 consecutive patients, (93 with ruptured aneurysms, 7 with asymptomatic aneurysms) were managed following a radio clinical investigation protocol. Preoperative evaluation included clinical grading (Hunt and Hess) (20 patients were GR I, 43 GR II, 19 GR III, 9 GR IV and 9 GR V) angiography and CTScan grading. The timing of surgery was determined according to angiographic, clinical and CTScan data: 73.2% of ruptured aneurysms were operated on between Day 0 and Day 3. Control angiography and control CT were performed 10-12 days after surgery (earlier in case of clinical deterioration). Post operative CTScan hypodensities were evaluated according to preoperative CT, preoperative angiography and post operative angiography: 32 hypodensities (8 without any symptom) were related to initial hemorrhage, vasospasm or post surgical thrombosis. In five cases the etiology was dobble. Angiographic control data showed 18 cases of vasospasm and 12 cases of post surgical thrombosis. We did not find any complication due to the control angiography. The outcome was classified according to the Glasgow Outcome Score (GOS): of 82 GR I.II.III (H & H) cases, the outcome was 73 GOS 1-2 cases, 3 GOS 3 Cases, 1 GOS 4 case and 5 GOS 5 cases. of 18 GR IV.V (H & H) cases, the outcome was 4 GOS 1-2 cases, 1 GOS 3 case, 1 GOS 4 case and 12 GOS 5 cases. In 28 GOS 2-3-4-5 cases, the cause of disability or death was under the main responsibility of the initial hemorrhage 13 times, of a thrombosis 11 times, of the vasospasm 4 times with associated non neurological problems in seven cases. When the control angiography is not performed and when the thrombosis is unrecognized sequellae or death can be erroneously attributed in many cases to the sole vasospasm or to the initial hemorrhage.(ABSTRACT TRUNCATED AT 250 WORDS)     

Surgical management of unruptured aneurysms: prognostic indicators

BACKGROUND: The treatment of unruptured aneurysms (UA) remains controversial. Therefore, it has become necessary to define various prognostic indicators in the surgical treatment of unruptured aneurysms not associated with previously ruptured aneurysms. METHODS: During a 6-year period, 78 unruptured aneurysms were managed. The results of management were retrospectively reviewed to define the prognostic indicators. RESULTS: There were 104 patients with unruptured aneurysms who underwent surgical treatment. Seventy-five patients without previous subarachnoid hemorrhage (SAH) were selected for data analysis. Eighty-seven percent of the aneurysms were on the anterior circulation. The most common location was the middle cerebral artery (MCA) followed by the posterior communicating artery (PCom), ophthalmic artery, and anterior communicating artery (ACom). Six percent were found on the basilar artery. The mean size of aneurysms was 12.5 mm (range = 3-30 mm, SD = 7.4). At surgery, rupture of the aneurysm was encountered in eight cases with temporary control of the parent vessel being required in 31 procedures. In four cases, intraoperative angiography warranted clip reapplication. The Glasgow Outcome Scale (GOS) was used as an outcome measure. Surgical treatment resulted in good outcome (GOS 1) in 87% and 10.7% had fair outcome; 2.3% were in GOS 3 (severe disability) at 6 month follow-up. There was no mortality. Logistic regression identified significant relationships between GOS and intraoperative rupture (p < 0.0002), rupture and size (p < 0.003), and size and age (p < 0.01). CONCLUSIONS: Large size aneurysms were associated with intraoperative rupture, which had a strong correlation with poor outcome. Increased age showed a linear relationship with the size of the aneurysm. Overall results of treatment for UA are gratifying. There was no mortality. Early diagnosis and surgical extirpation of UA may reduce both intraoperative difficulties as well as poor outcome probability.     

Blood blister-like aneurysms of the internal carotid artery trunk causing subarachnoid hemorrhage: treatment and outcome

OBJECT: The object of this study was to evaluate cases of subarachnoid hemorrhage (SAH) from ruptured blood blister-like aneurysms (BBAs) of the internal carotid artery (ICA) trunk. METHODS: The authors performed a single-center, retrospective study. Data analyzed were patient age, sex, Hunt and Hess grade, Fisher grade, time from SAH to hospitalization, aneurysm size and location, collateral capacity of the circle of Willis, time from hospitalization to aneurysm repair, type of aneurysm repair, complications, and Glasgow Outcome Scale (GOS) score at follow-up. RESULTS: A total of 211 patients suffered SAH from ICA aneurysms. Of these, 14 patients (6.6%) had ICA trunk BBAs; 6 men and 8 women. The median age was 47.8 years (range 29.9-67.7 years). The Hunt and Hess grade was IV or V in 7 cases, and SAH was Fisher Grade 3 + 4 in 6. All aneurysms were small (< 1 cm), without relation to vessel bifurcations, and usually located anteromedially on the ICA trunk. Three patients were treated with coil placement and 11 with clip placement. Of the 7 patients in whom the ICA was preserved, only 1 had poor outcome (GOS Score 2). In contrast, cerebral infarcts developed in all patients treated with ICA sacrifice, directly postoperatively in 2 and after delay in 5. Six patients died, 1 survived in poor condition (GOS Score 3; p < 0.001). CONCLUSIONS: Internal carotid BBAs are rare, small, and difficult to treat endovascularly, with only 2 of 14 patients successfully treated with coil placement. The BBAs rupture easily during surgery (ruptured in 6 of 11 surgical cases). Intraoperative aneurysm rupture invariably led to ICA trap ligation. Sacrifice of the ICA within 48 hours of an SAH led to very poor outcome, even in patients with adequate collateral capacity on preoperative angiograms, probably because of vasospasm-induced compromise of the cerebral collaterals.     

Treatment of ruptured intracranial aneurysms: our approach.

OBJECTIVE: Subarachnoid hemorrhage (SAH) often results in devastating neurological deficits requiring hospitalization and loss of independence. This is often a difficult time for patients and their families who are struggling to cope with this sudden illness. Current treatment options include surgical clipping of the aneurysm or endovascular obliteration using Guglielmi detachable coils. Our purpose in writing this paper was to review the factors that determine the choice of treatment. In addition to this we wanted to study the benefits of surgical clipping for ruptured aneurysms over endovascular coiling. MATERIAL AND METHODS: We studied--retrospectively--450 cases of ruptured cerebral aneurysms admitted to our institution from 1997 to 2003. Out of these, 324 were subjected to surgical clipping and 126 to endovascular techniques. The outcome was studied using the Glasgow Outcome Score (GOS). RESULTS: Of the 324 cases of surgical clipping 222 had a good recovery, 38 had moderate disability, 15 had severe disability, 13 became vegetative and 36 patients died. In the endovascular group 34 had a good recovery, 22 had moderate disability, 18 had severe disability, 15 became vegetative and 37 patients died. Grade to Outcome was compared for both forms of treatment. In our series clipping for ruptured aneurysm was preferred to coiling in fusiform-shaped aneurysms, large or giant aneurysms, MCA aneurysms, blister aneurysms, complex configurations, partially thrombosed aneurysms and aneurysms associated with cerebral hemorrhage. Coiling was performed for basilar tip and trunk aneurysms, high anterior communicating artery aneurysms, patients in subacute stages of subarachnoid hemorrhage, and those with associated medical complications. CONCLUSION: Based on this study we were able to formulate a few definite indications for clipping, even in the times of advanced endovascular techniques. In addition we could also prove the benefits of surgical clipping over the endovascular technique in severe subarachnoid hemorrhage.     

The impact of endovascular treatment on cerebral aneurysm outcome at Groote Schuur Hospital.

OBJECTIVES: Neuro-endovascular treatment was introduced at Groote Schuur Hospital in 2001. We sought to assess whether this has resulted in a change in overall outcomes for patients treated for cerebral aneurysms. DESIGN: Retrospective cohort study. The first cohort included cerebral aneurysm patients seen between 1994 and 1998 when only surgical treatment was available. The second cohort consisted of a group treated using both surgical and endovascular methods between 2002 and 2004. SUBJECTS: Patients with ruptured and unruptured aneurysms were included in the study. OUTCOME MEASURES: The Glasgow Outcome Score (GOS) wasused to assess outcome. The primary comparator between groups was major disability (GOS 3 and 2) and death (GOS 1). RESULTS: Cohorts were comparable regarding age, sex and presenting clinical condition as assessed using the World Federation of Neurological Surgeons grading for subarachnoid haemorrhage. There was an absolute reduction in major disability and death of 16% in the later cohort where 55% of patients had endovascular treatment. CONCLUSIONS: The option of endovascular treatment for cerebral aneurysms at Groote Schuur Hospital has allowed for more rapid treatment of patients, which has reduced morbidity and mortality from re-bleeding. We are also able to select the best treatment option for each patient and believe this has contributed to our improved results.     

Application of a rigid endoscope to the microsurgical management of 54 cerebral aneurysms: results in 48 patients.

OBJECT: To enhance visual confirmation of regional anatomy, endoscopy was introduced during microsurgery for cerebral aneurysms. The risks and benefits are analyzed in the present study. METHODS: The endoscopic technique was used during microsurgery for 54 aneurysms in 48 patients. Forty-three aneurysms were located in the anterior circulation and 11 were in the posterior circulation. Thirty-eight aneurysms (70.4%) had not ruptured. All ruptured aneurysms in the present series produced Hunt and Hess Grade I or II subarachnoid hemorrhage. After initial exposure achieved with the aid of a microscope, the rigid endoscope was introduced to confirm the regional anatomy, including the aneurysm neck and adjacent structures. The necks of 43 aneurysms were clipped using microscopic control or simultaneous microscopic/endoscopic control. After clipping, the positions of the clip and nearby structures were inspected using the endoscope. Use of the neuroendoscope provided useful information that further clarified the regional anatomy in 44 cases (81.5%) either before or after neck clipping. In nine cases (16.7%), these details were available only with the use of the endoscope. In five cases (9.3%), the surgeons reapplied the clip on the basis of endoscopic information obtained after the initial clipping. There were two cases in which surgical complications were possibly related to the endoscopic procedures (one patient with asymptomatic cerebral contusion and another with transient oculomotor palsy). CONCLUSIONS: It is the authors' impression that the use of the endoscope in the microsurgical management of cerebral aneurysms enhanced the safety and reliability of the surgery. However, there is a prerequisite for the surgeon to be familiar with this instrumentation and fully prepared for the risks and inconveniences of endoscopic procedures.     

Endovascular surgery for very small ruptured intracranial aneurysms. Technical note

Application of endovascular surgery for very small aneurysms is controversial because of technical difficulties and high complication rates. The aim in the present study was to assess treatment results in a series of such lesions at one institution. Since 1997, endovascular surgery has been advocated for very small ruptured aneurysms (< 3 mm in maximum diameter) that fulfill the criterion of a fundus/neck ratio greater than 1.5. Twenty-one patients were treated, for whom the World Federation of Neurosurgical Societies classification before treatment was Grade I in 10, Grade II in two, Grade III in two, Grade IV in five, and Grade V in two. The aneurysm location was the internal carotid artery in four, the anterior communicating artery in 11, the middle cerebral artery in one, and the vertebrobasilar system in five. In all patients, endovascular surgery was performed using Guglielmi detachable coils after induction of general anesthesia. Initially, the presumed volume of the lesions was calculated for each aneurysm. Thereafter, the appropriate coil length was decided according to the volume embolization ratio, as 30 to 40%. In all attempts to obliterate aneurysms a single coil was used. All aneurysms were completely obliterated as confirmed by postembolization angiography, without procedure-related complications. During the follow-up period only one patient needed additional coil embolization for a growing aneurysm. Final outcomes were good recovery in 15 patients, moderate disability in five, and severe disability in one. Appropriate selection of patients and coils, and use of sophisticated techniques allow a good outcome for patients with very small aneurysms.     

New clinical grading in ruptured cerebral aneurysm

A new clinical grading of subarachnoid hemorrhage (SAH) due to ruptured aneurysm, classified by the presence or absence of vomiting, and by the duration of initial unconciousness at the time of bleeding, is proposed. Grade I: headache without vomiting, Grade II: headache, vomiting, and/or loss of consciousness lasting less than one hour, Grade III: loss of consciouness for over one hour. Grade IV: permanent unconsciousness or cerebral herniation signs. Based on the clinical records, 142 cases of ruptured cerebral aneurysms directly operated on in phases varying from peracute phase (within 72 hours) to delayed phase (22 days or over) were retrospectively analyzed. They included 99 cases which were operated on under microscope. The Hunt & Hess grading was applied just before surgery. Outcome at the 6 month to 1 year follow-up was rated as good, fair, poor and dead. Correlations between the severity and the outcome were calculated using the chi-square test and the levels of significance were compared with those between the recent Hunt and Hess grading and the outcome. In the total of 142 cases, correlation between the clinical severity and the outcome was significant (P less than 0.0005), whereas correlation between the Hunt & Hess grading and the outcome was not significant. In the analysis of cases classified by the operative timing, the clinical severity showed good correlation in the peracute (within 72 hours after SAH) (P less than 0.05) alone, while Hunt & Hess grading showed correlation in delayed phase alone. Neither of the gradings was significant in the acute phase or subacute phase.(ABSTRACT TRUNCATED AT 250 WORDS)