Tribute to William Edward Hunt and Robert McDonald Hess Jr. Pioneers in the Clinical Classification of Ruptured Intracranial Aneurysms

William Edward Hunt (1921–1999) and Robert McDonald Hess Jr. (1931–2019) were pioneers in revolutionizing the early surgical management of ruptured intracranial aneurysms. Early on in his career as a professor of neurosurgery at Ohio State University, Dr. Hunt adopted a systematic method to identify clinical symptoms of patients presenting with subarachnoid hemorrhage as candidates for either immediate or delayed surgery. As an Ohio State University neurosurgery resident, Dr. Hess was an active key collaborator in Dr. Hunt's aneurysm studies. Described as a modification of the Botterell classification system, the Hunt-Hess scale grading the survival risk of undergoing immediate intracranial aneurysm surgery was implemented and validated across an 18-year consecutive patient series at White Cross Hospital, Columbus, Ohio. Dr. Hunt and Dr. Hess demonstrated that for patients with subarachnoid hemorrhage on admission with Hunt-Hess grades I and II, indicating retained consciousness and minimal neurological deficits, immediate surgical management afforded a <20% mortality rate. In comparison, patients with grade III or higher had a >50% mortality rate, suggesting that conservative management should be instead pursued. As the principal investigator, Dr. Hunt was widely regarded internationally as an expert in the field of treating intracranial aneurysms, eventually serving as a World Federation of Neurosurgical Societies (WFNS) committee member to also publish a universal subarachnoid hemorrhage grading scale. To pay tribute to Drs. Hunt and Hess for their substantial contributions, we present historical vignettes of their lives along with highlighting the role of the Hunt-Hess classification system in transforming management of ruptured aneurysms.