Nuestra experiencia en 53 casos operados en 3 años]]> Objetivos: analizar las relaciones entre la gradación de Hunt-Hess, la escala de Fisher tornográfica, la incidencia de vasoespasmo , la estrategia y la técnica quirúrgica como factores relevantes en la evolución.
Material y métodos: nuestros 53 pacientes se distribuyeron de la siguiente manera:
- Score de Hunt-Hess : grado O: un paciente ; grado I : 17 pacientes ; grado II: 25 pacientes; grado III: 8 pacientes; grado IV ninguno, y grado V :un paciente.
- Escala de Fisher: grado I: 3 casos ; grado II: 28 casos, grado III : 11 casos y grado IV: 11 casos.
- Vasoespasmo clínico y / o angiográfico : en 17 pacientes.
- Estrategia quirúrgica: cirugía precoz en 25 casos.
Resultados: la mortalidad en los casos con Hunt-Hess grados 1 y 2 fue del 2,7%, en 33 pacientes se constató una muy buena evolución y en 8 casos una buena evolución. La mortalidad fue del 50 % en los grados 3 a 5.
Conclusión: se observó evolución favorable en los pacientes intervenidos con Hunt­Hess 1 y 2, en comparación con aquellos en grados 3 a 5. Se evidencia como elemento singular relevante en el pronóstico el nivel de conciencia prequirúrgico con respecto a las demás variables.]]> Objetives: To analyze the relationship between the Hunt and Hess grading system, Fisher tomographic scale, vasospasm incidence, surgical strategy and technic as relevant factors in patient outcome.
Material and Methods: Our 53 patients showed the following distribution :
- Hunt and Hess grade 0: one patient; grade I: 17 patients; grade II: 25 patients; grade III: 8 patients; grade IV: none and grade V: 1 patient.
- Fisher scale. Grade I: 3 cases; grade II: 28 cases; grade III: 11 cases and grade IV: 11 cases. Clinical and/ or angiographic vasospasm: 17 patients.
- Surgical strategy: early surgery in 25 cases.
Results: Patients belonging to Hunt and Hess grades 1 and 2 had a 2.7% mortality rate with a very good outcome in 33 cases and good outcome in 8. Grades 3 to 5 had an overall mortality of 50%.
Conclusion: A good outcome was observed in patients included in Hunt and Hess grades 1 and 2 as compared to patients in grades 3 to 5. Furthermore, the patients presurgical consciousness level resulted in the single most important prognostic factor.]]> Aring CD: A medical perspective. Neurology 34: 1.357-1.361, 1984.
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