Artikel
Quality of life comparison after clipping of unruptured and low-grade subarachnoid haemorrhage aneurysms
Vergleich der Lebensqualität nach Clipping unrupturierter Aneurysmen und Clipping mit leichtgradigen Subarachnoidalblutungen
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Autoren
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Michelle Lehmann
- Carl Gustav Carus Universitätsklinikum, TU Dresden, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
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Dino Podlesek
- Carl Gustav Carus Universitätsklinikum, TU Dresden, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
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Stephan B. Sobottka
- Carl Gustav Carus Universitätsklinikum, TU Dresden, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
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Matthias Kirsch
- Asklepios Kliniken Schildautal, Klinik für Neurochirurgie, Seesen, Deutschland
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Gabriele Schackert
- Carl Gustav Carus Universitätsklinikum, TU Dresden, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
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Witold H. Polanski
- Carl Gustav Carus Universitätsklinikum, TU Dresden, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
| Veröffentlicht: | 25. Mai 2022 |
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Gliederung
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Objective: Clipping of intracranial aneurysms is a well-established treatment for unruptured and ruptured aneurysms in neurosurgery. The aim of the study was to investigate whether there are differences in outcome between patients clipped on incidental and those clipped on ruptured aneurysms with low grade subarachnoid hemorrhage (SAH; Hunt & Hess grade 1 and 2).
Methods: Hundred-and-four patients with low grade SAH H&H grade 1 and 2 and 130 patients with electively clipped (EC) aneurysms were included in the study. Patients' characteristics, comorbidities, treatment related complications and outcome were collected from the electronic medical records. In addition, the outcome data of 53 patients with SAH and 67 EC patients were gathered via phone interview. Quality of life was assessed on the Glasgow Outcome Scale Extended (GOSE), the modified Rankin Scale (mRS) and the grading system of the World Federation of Neurosurgical Societies (WFNS). Statistics were performed by using Pearson's chi-square test, Mann-Whitney U test and Kruskal-Wallis test in uni- and multivariate analysis.
Results: The median age of EC and SAH patients H&H grade 1 and 2 was 60.0 vs 53.2 years. The gender distribution was 2:1 female to male ratio in both groups. The number of comorbidities was higher in the EC group: hypertension (71.5% vs. 45.2%) and nicotine consumption (37.7% vs. 14.4%). EC patients developed less complications than SAH patients: hydrocephalus (1.5% vs. 48.1%) and vasospasm (10.0% vs. 41.3%). 70-90% of EC patients showed little to no afflictions in the used outcome scores compared to low-grade SAH patients (Table 1 [Tab. 1]). There was no change in quality of life after a median follow-up time of 6.4 years (SAH) and 5.7 years (EC). Independent risk factors for a poor outcome in daily life (1-4 points in the GOSE) are shown in Table 2 [Tab. 2].
Conclusion: Clipping of unruptured aneurysms causes less afflictions in everyday life. The overall outcome is better after EC than after low-grade SAH aneurysm clipping. Even a mild SAH can lead to severe complications with quality of life restrictions.
