gms | German Medical Science

Objective: The aim of the study was to compare the clinical outcome of patients with a poor-grade aneurysmatic subarachnoid hemorrhage (aSAH) with measurable volumetric data on the initial cranial CT scan.

Methods: In a retrospective study clinical data of all patients treated in our neurosurgical department between 2008 and 2013 and admitted with a poor-grade aSAH (Hunt & Hess grade IV or V) was collected. All patients with a cranial computed tomography (CCT) scan not older than three days after the bleeding were included. The volumetric analysis was carried out with Analyze 12.0 (AnalyzeDirect). We calculated the blood volume of the basal cisterns as well as the subarachnoid blood, the intraventricular blood and the intraparenchymal blood volume. The clinical data was extracted from the clinical charts during the in-patient stay. A follow-up examination was performed two years after the aSAH if possible. Patients with no follow up information available were assumed with an unfavorable extended Glasgow outcome score (1-4). We compared volumetric data with the extended Glasgow outcome scale, the development of delayed cerebral ischemia (DCI), the need for a ventriculoperitoneal shunt implantation and the need for a decompressive craniectomy.

Results: A total of 80 patients were admitted to our neurosurgical intensive care unit with an aSAH Hunt and Hess grade IV or V. A favorable outcome (extended Glasgow outcome score 5-8) was achieved by 11 % of patients on discharge and by 26,3 % after two years. High ventricular cerebrospinal fluid (CSF) volumes were associated with a better outcome two years after the aSAH (p=0,019). Lower ventricular CSF volumes (p=0,005), larger intraparenchymal blood volumes (p=0,001) and larger intraventricular blood volumes (p=0,028) were associated with a decompressive craniectomy being performed during the in-patient stay. Higher volumes of subarachnoid blood correlated with the occurrence of DCI visible on the CCT scan 6 weeks after the aSAH (p=0,012). DCIs were associated with an unfavorable outcome on discharge (p=0,04). No relation between blood or ventricular volumes and the need for a VP-Shunt-implantation was found. Furthermore, there was no correlation between ventricular or blood volumes and patient age. A higher age on admission correlated with a worse outcome on discharge as well as on follow-up after two years (p<0,001).

Conclusion: Our findings showed that a notable rate of patients with poor grade aSAH achieved a favorable outcome after a two-year follow-up period. A larger ventricular CSF volume was identified as a marker for a favorable outcome. We could also identify risk factors for the development of DCIs as well as the need for a decompressive craniectomy.