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  • Early Surgery in Patients Suffering Poor Grade Aneurysmal Subarachnoid Hemorrhage: A Single Institution Experience

    Final Number:

    Anastasia Tasiou; Konstantinos Vagkopoulos; Thanasis Paschalis; Theofanis Giannis; Iordanis Georgiadis; Themistoklis Papasilekas; Alexandros G. Brotis; Eleni Tsianaka; Haralambos Gatos; Kostas N. Fountas

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: It is well known that rupture of an intracranial aneurysm constitutes the most common cause of spontaneous subarachnoid hemorrhage (sSAH). Poor grade sSAH patients are characterized by a high rate of morbidity and mortality. In our current cohort, we present our results regarding the outcome of poor grade aneurysmal sSAH patients.

    Methods: Twenty two patients (15M and 7F), in a poor clinical grade according to the Hunt and Hess grading scale on admission, were included in our retrospective study (January 2009 to December 2015). The mean age was 52.6 years (range 39-74). All participants with CT-established diagnosis of SAH, underwent CT angiography (CTA) for identification of the source of hemorrhage. The severity of SAH was assessed by the Fisher grade classification scale. Digital subtraction angiography (DSA) was performed in a very limited number of patients (7 patients). All patients were treated surgically and their clinical outcome was evaluated by applying the Glasgow Outcome Scale (GOS). The mean follow-up time in our study was 10.1 months (range 0.13-60 months).

    Results: All of our patients were presented in a poor grade with Hunt and Hess grades of IV and V on admission (23% and 77%, respectively). The vast majority of our patients (68%) were operated on within 24h after the SAH onset. Fourteen out of sixteen (87.5%) treated within 24 h were Fisher grade 4. Overall, the 6 months postoperative outcome was favorable (GOS 4/5) for 6 patients (27.3%), while an unfavorable outcome occurred in 16 patients (72.7%). The mortality rate in our cohort was 50%. The most common cause of death was septicemia.

    Conclusions: Despite the belief that severe aSAH is a devastating disease, even poor grade patients may achieve favorable outcome with early operative intervention. A larger volume series is necessary for accurately outlining the prognosis of this entity, and also identifying those parameters which could predict good outcome.

    Patient Care: We hope that this research will be helpfull by highlighting that even poor grade aSAH patients may achieve favorable outcome with early operative intervention.

    Learning Objectives: By the conclusion of this session, participants should be able to: • realize that even poor grade aneurysmal sSAH patients may achieve favorable outcomes • early operative intervention is necessary for that • it is necessary to identify parameters that could predict good outcome

    References: 1. Velthuis BK, Rinkel GJ, Ramos LM, Witkamp TD, Berkelbach van der Sprenkel JW, Vandertop WP, van Leeuwen MS: Subarachnoid hemorrhage: aneurysm detection and preoperative evaluation with CT angiography. Radiology 1998, 208:423–430 2. Laidlaw JD, Siu KH: Poor-grade aneurysmal subarachnoid hemorrhage: outcome after treatment with urgent surgery. Neurosurgery 2003, 53:1275–1282. 3. Nieuwkamp DJ, Setz LE, Algra A, et al. Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: a meta-analysis. Lancet Neurol 2009;8:635–42.

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