The Timing of Anterior Communicating Artery Aneurysm Surgery: Comparison of Outcome in Early Versus Intermediate Surgery

Abstract

The authors analyzed 47 cases of ruptured anterior communicating artery aneurysms during the past three years that were clipped within 14 days after initial hemorrhage, to study the influence of the timing of surgery on the development of vasospasm-related complications. Twelve patients were operated within three days after the onset of subarachnoid hemorrhage (SAH) (early group), and 35 patients were operated 4-14 days after SAH (intermediate group). For the statistical analysis the chi-square test with Yates' correction and Fisher's exact test were used. There were no statistically significant differences between the early and the intermediate groups in (1) the Hunt-Hess grade on admission and preoperatively, (2) the final outcome, (3) the presence of associated diseases, or (4) the occurrence of angiographic vasospasm. There was no difference in the preoperative medical management. The occurrence of symptomatic vasospasm or infarct was not different in the early and intermediate groups (p)0.10), nor was the occurrence of infarct in the anterior cerebral artery (ACA) or non-ACA territory (p)0.10). Laterality of infarct was not related to laterality of surgical approach in either the early or intermediate groups, nor in the whole group (p) 0.10). Hydrocephalus, rebleeding, and other complications were also not different in the early and intermediate groups. The authors did not find any evidence that in patients with ruptured anterior communicating artery aneurysms, the timing of surgery affects the development of vasospasm-related complications.