Impact of Preoperative WFNS, Hunt-Hess, and Fisher Scores, Surgical Timing, and Saline Use on Mortality and Vasospasm in Aneurysmal Subarachnoid Hemorrhage

Abstract

Background: Aneurysmal subarachnoid hemorrhage (aSAH) remains a life-threatening neurosurgical emergency with high morbidity and mortality. Preoperative neurological grading systems such as WFNS, Hunt-Hess, and Fisher scales are important prognostic indicators, while the optimal timing of surgery and the role of hypertonic saline use are still debated. Objective: This study aimed to evaluate the impact of preoperative WFNS, Hunt-Hess, and Fisher scores, surgical timing, and perioperative hypertonic saline use on the development of vasospasm and six-month mortality in patients with aSAH. Methods: A retrospective analysis was conducted on 179 patients who underwent microsurgical clipping for aSAH between 2015 and 2022. Demographic, clinical, and radiological data were collected. Patients were grouped according to surgical timing: ultra-early (<24 h), early (2–3 days), intermediate (4–10 days), and delayed (>11 days). Outcomes included vasospasm and six-month survival. Statistical significance was set at p<0.05. Results: Vasospasm occurred in 26.2% of patients, being significantly more frequent in those operated within 24 hours (p=0.003). High WFNS (p=0.002), Fisher (p=0.001), and Hunt-Hess scores were associated with vasospasm and poor outcomes. Six-month mortality was 17.9%, with the highest rates in patients with Fisher grade 4, WFNS grade 5, and Hunt-Hess grade 5 (all p<0.001). Early surgical timing (<24 h) was linked to increased mortality (p=0.044). Hypertonic saline use (34.1%) showed no significant effect on vasospasm or mortality (p>0.05). Hydrocephalus was significantly associated with worse prognosis (p=0.040). Conclusion: High preoperative WFNS, Hunt-Hess, and Fisher scores, as well as ultra-early surgical timing, are independent predictors of poor outcomes in aSAH. Hypertonic saline use did not significantly affect vasospasm or survival. Risk stratification with clinical and radiological grading remains essential, and surgical timing should be individualized based on patient stability.

Keywords

• Subarachnoid hemorrhage
• WFNS
• Hunt-Hess
• Fisher scale
• Surgical timing
• Vasospasm

Project Number

B.10.1.TKH.4.34.H.GP.0.01/48.

Ethical Statement

This study was conducted with the approval of the Ethics Committee of Ümraniye Training and Research Hospital, numbered B.10.1.TKH.4.34.H.GP.0.01/48.

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