Timing of Treatment for Ruptured Cerebral Aneurysms: Impact on Clinical Outcome. A Case Series from a Tertiary Center.

Abstract

Aneurysmal subarachnoid hemorrhage is a life-threatening emergency where timely intervention is crucial to reduce rebleeding and improve outcomes. This study aimed to assess the impact of treatment timing-from initial cranial computed tomography to surgical or endovascular intervention-on clinical outcomes in a single-center cohort. We retrospectively analyzed patients with ruptured intracranial aneurysms treated between January 2022 and December 2024. Demographics, Fisher grade, treatment modality, timing of intervention, complications, and external ventricular drain (EVD) placement were recorded. Outcomes were classified as good recovery, dependent in activities of daily living, or deceased. Logistic regression identified predictors of poor outcome and mortality. Among 74 patients with follow-up, 91.9% were treated within 24 hours of diagnosis (mean delay: clipping 16 hours; coiling 10 hours). No significant outcome difference was observed between early and later treatment within this 24-hour window. Higher Fisher grade independently predicted mortality, with grades 3 and 4 associated with significantly lower survival compared to grade 2. Pretreatment EVD placement showed a nonsignificant trend toward better outcomes. In our experience, timely treatment within 24 hours remains a safe and effective strategy, while accelerating intervention to within a few hours did not confer additional benefit for most patients. Fisher grade remains a strong predictor of outcome, underscoring the value of radiological severity in prognostic assessment. Early EVD placement may offer benefit in selected patients, but further prospective studies are warranted to clarify its role in outcome improvement.