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66th Annual Meeting of the German Society of Neurosurgery (DGNC)
Friendship Meeting with the Italian Society of Neurosurgery (SINch)

German Society of Neurosurgery (DGNC)

7 - 10 June 2015, Karlsruhe

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Poor-grade aneurysmal subarachnoid hemorrhage: factors influencing outcome in severely ill patients – a single center series

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  • Patrick Schuss - Klinik für Neurochirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn
  • Alexis Hadjiathanasiou - Klinik für Neurochirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn
  • Valeri Borger - Klinik für Neurochirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn
  • Christian Wispel - Klinik für Neurochirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn
  • Hartmut Vatter - Klinik für Neurochirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn
  • Erdem Güresir - Klinik für Neurochirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocMO.02.01

doi: 10.3205/15dgnc007, urn:nbn:de:0183-15dgnc0078

Published: June 2, 2015

© 2015 Schuss et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Patients presenting with poor-grade aneurysmal subarachnoid hemorrhage (SAH) are known to have a poor prognosis. Nevertheless, several reports suggest favourable outcome in some of these severely ill patients, especially after early and aggressive treatment. However, aggressive therapy in poor-grade patients with SAH is still controversially discussed. We therefore analyzed our database to identify factors determining functional outcome after poor-grade SAH.

Method: From 2004 to 2014, 248 patients suffering from poor-grade SAH were treated at our institution. Poor-grade SAH was defined as Hunt & Hess (H&H) grades IV and V on admission. Information, including patient characteristics, treatment modality, aneurysm size and location, radiological features, and functional neurological outcome were assessed and further analyzed. Outcome was assessed according to the modified Rankin Scale (mRS) at 6 months and stratified into favourable (mRS 0-3) versus unfavourable (mRS 4-6). A multivariate analysis was performed to identify predictors of functional outcome.

Results: Overall 80 of 248 patients suffering from poor-grade SAH achieved favourable outcome (28%). Patients with favourable outcome were significantly younger compared to patients with unfavourable outcome (p=0.0003). Patients with favourable outcome admitted with a significantly lower mean H&H grade (p<0.0001) and harbored significantly smaller aneurysms compared to patients with unfavourable outcome (p=0.003). Patients presenting with additional space-occupying intracranial hemorrhage achieved significantly more often unfavourable outcome compared to patients without ICH (p=0.007). Rebleeding after diagnosis but before aneurysm treatment was associated with unfavourable outcome (p=0.02). On multivariate analysis, patients age, initial H&H grade, aneurysm size, and rebleeding before and after aneurysm treatment, were identified as significant predictors of functional outcome in patients with poor-grade SAH.

Conclusions: We provide detailed data on possible predictors of functional outcome in patients with poor-grade SAH. However, favourable outcome was achieved in 28% of these severely ill patients. Therefore, treatment of patients with poor-grade SAH should not be omitted, but careful individual decision-making is necessary for each patient.