gms | German Medical Science

65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

Functional long-term outcome and quality of life after aneurysmal subarachnoid hemorrhage WFNS grade IV and V

Meeting Abstract

  • Christoph Schwartz - Neurochirurgische Klinik, Klinikum der Universität München
  • Thomas Pfefferkorn - Neurologische Klinik, Klinikum der Universität München
  • Gunther Fesl - Abteilung für Neuroradiologie, Klinikum der Universität München
  • Hans-Walter Pfister - Neurologische Klinik, Klinikum der Universität München
  • Jörg-Christian Tonn - Neurochirurgische Klinik, Klinikum der Universität München
  • Christian Schichor - Neurochirurgische Klinik, Klinikum der Universität München

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocMO.08.09

doi: 10.3205/14dgnc043, urn:nbn:de:0183-14dgnc0438

Published: May 13, 2014

© 2014 Schwartz et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Among patients with aneurysmal subarachnoid hemorrhage (aSAH) WFNS grades IV and V are associated with poor clinical and neurological outcome. However, several recently published clinical series suggest that a substantial proportion of these patients regain functional independency. Therefore, we performed this study focusing on the functional outcome assessment of this subgroup of patients.

Method: In this single-center retrospective study we analyzed long-term functional outcome (modified Rankin scale: mRS) and quality of life (36-item short-form health survey: SF 36) in all consecutive patients with poor-grade aSAH (WFNS IV and V) who received early aneurysm repair at our institutions between 2005 and 2010. Detailed patient information was retrieved from the medical charts and included age, sex, co-morbidity, risk factors, clinical presentation including the Glasgow Coma Score (GCS), time to aneurysm repair, modality of aneurysm repair, complications and TCD measurements. Statistical analyses were performed by the fisher’s exact test and logistic regression models.

Results: A total of 107 eligible patients (29 male, 78 female) were identified. Mean age at SAH was 54.7 years. All patients received aneurysm repair within 72 hours of symptom onset either by coiling in 72 patients (67%) or clipping in 35 patients (33%). Within a median follow-up interval of 3.2 years (range 1.0-6.6 years) ten (9%) patients were lost to long-term follow-up. Among the remaining 97 patients a total of 35 patients (36%) had died. MRS scores could be obtained in all 62 survivors of which 40 (65%) were assessed as functionally independent (mRS≤2). In the multivariate logistic regression analyses advanced age (>median of 53 years, p<0.001) and radiological evidence of infarction (p=0.03) predicted poor functional long-term outcome (mRS>2). Quality of life was perceived moderately reduced compared to a healthy age- and sex-matched German population. Compared to a historical mainly good-grade SAH population, the item emotional role functioning was rated substantially lower.

Conclusions: WFNS grade IV and V aSAH is not necessarily associated with poor long-term outcome, especially in younger patients. After early aneurysm repair, about two thirds of patients survive. Among survivors about two thirds regain long-term functional independency. Quality of life in survivors seems to be relatively good, but emotional problems may be a persisting burden.