Factors related to the prognosis of patients with cerebral aneurysms undergoing microsurgical treatment.

[BACKGROUND] Subarachnoid hemorrhage secondary to a ruptured brain aneurysm should be promptly diagnosed. The angiographic study allows the diagnosis of vascular alterations that determine subarachnoid hemorrhage. The risk of rebleeding is highest in the first 24 h following the first bleeding. The prognosis of the surgical treatment of a brain aneurysm depends on many factors.

[OBJECTIVE] The aim of the present retrospective study was to determine which prognostic factors are related to the morbidity and mortality of the microsurgical treatment of different brain aneurysms.

[METHODS] A total sample of 371 patients with subarachnoid hemorrhage due to aneurysm bleeding treated by microsurgery from 2013 to 2022 were studied. The variables studied were patient characteristics (age, gender, smoking status, systemic arterial hypertension, and diabetes mellitus), the tomographic findings classified by the Fisher scale, the interval between stroke and surgery, and the clinical condition of patients at admission classified by the Hunt-Hess scale. The primary outcome was the occurrence of death, and the secondary outcomes were the length of hospital stay and the length of stay in the intensive care unit.

[RESULTS] The clinical presentation (characterized by the Hunt-Hess scale) at the time of admission of the patient was an important determining factor in the length of hospital stay and intensive care unit stay and the occurrence of death in these patients. Older age and occurrence of diabetes mellitus were also associated with the outcome of death. The surgical moment characterized by the time between stroke and surgery was inversely associated with the outcome of death.

[CONCLUSION] The timing for surgery has to be analyzed concerning the clinical presentation of the patient at the time of admission.