Intermediate surgical outcome in patients suffering poor-grade aneurysmal subarachnoid hemorrhage. A single center experience

• Published in: International journal of neuroscience 2022-01, Vol.132 (1), p.38-50
• Main Authors: Tasiou, Anastasia, Brotis, Alexandros G., Paschalis, Thanasis, Tzerefos, Christos, Kapsalaki, Eftychia Z., Giannis, Theofanis, Tzannis, Alkiviadis, Fountas, Kostas N.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aneurysmal subarachnoid hemorrhage; Computed Tomography Angiography; Female; Fisher grade; Follow-Up Studies; Humans; Hunt and Hess grade; Intracranial Aneurysm - complications; Intracranial Aneurysm - diagnosis; Intracranial Aneurysm - mortality; Intracranial Aneurysm - surgery; Male; Middle Aged; Neurosurgical Procedures; outcome; Outcome Assessment, Health Care; prognostic factors; Retrospective Studies; Severity of Illness Index; Subarachnoid Hemorrhage - diagnosis; Subarachnoid Hemorrhage - etiology; Subarachnoid Hemorrhage - mortality; Subarachnoid Hemorrhage - surgery; surgical treatment
• ISSN: 0020-7454; 1563-5279; 1543-5245
• DOI: 10.1080/00207454.2020.1801676

It is known that patients suffering poor-grade aneurysmal subarachnoid hemorrhage (aSAH) have a dismal prognosis. The importance of early intervention is well established in the pertinent literature. Our aim was to assess the functional outcome and overall survival of these patients undergoing surgical clipping. In the current retrospective study we included all consecutive poor-grade patients after spontaneous SAH who presented at our institution over an eight-year period. All participants suffering SAH underwent brain CT angiography (CTA) to identify the source of hemorrhage. We assessed the severity of hemorrhage according to the Fisher grade classification scale. All patients were surgically treated. The functional outcome was evaluated six months after the onset with the Glasgow Outcome Scale. Finally, we performed logistic and Cox regression analyses to identify potential prognostic risk factors. Our study included twenty-three patients with a mean age of 53 years. Five (22%) patients presented with Hunt and Hess grade IV, and eighteen (78%) with grade V. The mean follow-up was 15.8 months, while the overall mortality rate was 48%. The six-month functional outcome was favorable in 6 (26%) patients. The vast majority of our patients died between the 15 th and the 60 th post-ictal days. We did not identify any statistically significant prognostic factors related to the patient's outcome and/or survival. Poor-grade aSAH patients may have a favorable outcome with proper surgical management. Large-scale studies are necessary for accurately outlining the prognosis of this entity, and identifying parameters that could be predictive of outcome.