Turkish Neurosurgery
Efficacy of Early Rehabilitation after Surgical Repair of Acute Aneurysmal Subarachnoid Hemorrhage: Outcomes after Verticalization on Day 2-5 versus Day 12 Post-Bleeding
Andjela Milovanovic2, Danica Grujicic2, Vojislav Bogosavljevic2, Milos Jokovic2, Natasa Mujovic2, Ivana Petronic Markovic2
1Clinical Centre of Serbia, Physical Medicine and Rehabilitation, Belgrade,
2School of Medicine, University of Belgrade, Belgrade,
3Clinical Centre of Serbia, Neurosurgery Clinic, Belgrade,
4University Children\'s Hospital, Department of Physical Medicine and Rehabilitation, Belgrade,
DOI: 10.5137/1019-5149.JTN.17711-16.1

Aim:To develop a specific rehabilitation protocol for patients who have undergone surgical repair of acute aneurysmal subarachnoid hemorrhage (aSAH), and to determine the time at which verticalization should be initiated after aSAH. Material and Methods:Sixty-five patients who underwent acute-term surgery for aSAH and early rehabilitation were evaluated in groups: Group 1 (n=34) started verticalization on Days 2-5 post-bleeding whereas Group 2 (n=31) started verticalization approximately Day 12 post-bleeding. All patients were monitored for early complications, vasospasm and ischemia. Assessments of motor status, depression and anxiety (using Zung scales), and cognitive status (using the Mini-Mental State Examination) were conducted at discharge and at 1 and 3 months post-surgery. Results:At discharge, Group 1 had a significantly higher proportion of patients with ischemia than Group 2 (p=0.004). Group 1 had a higher proportion of patients with hemiparesis than Group 2 three months post-surgery (p=0.015). Group 1 patients scored significantly higher on the Zung depression scale than Group 2 patients at 1 month (p=0.005) and 3 months post-surgery (p=0.001); the same applies to the Zung anxiety scale (p=0.006 and p=0.000, respectively). Group 2 patients scored significantly higher on the MMSE than those in Group 1 at discharge (p=0.040) and 1 month post-surgery (p=0.025). Conclusion:Early verticalization had no effect with respect to preventing early postoperative complications in this patient group. Once a patient has undergone acute surgical repair of aSAH, it is safe and preferred that rehabilitation be initiated immediately post-surgery. However, verticalization should not start prior to Day 12 post-bleeding.

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