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72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

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The SEBES score predicts the need for conservative ICP treatment and decompressive craniectomy after subarachnoid haemorrhage

SEBES-Score vorhersagt die Notwendigkeit der konservativen Hirndrucktherapie und dekompressiven Kraniektomie nach Subarachnoidalblutung

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  • presenting/speaker Maryam Said - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Leonie Droste - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Annika Herten - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Marvin Darkwah Oppong - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Anne-Kathrin Uerschels - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Daniela Pierscianek - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Philipp Dammann - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Karsten Henning Wrede - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Ulrich Sure - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
  • Ramazan Jabbarli - Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocV275

doi: 10.3205/21dgnc260, urn:nbn:de:0183-21dgnc2606

Published: June 4, 2021

© 2021 Said 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

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Objective: The severity of early brain edema after aneurysm rupture was reported to be strongly associated with the risk of cerebral infarction and unfavorable outcome in patients with aneurysmal subarachnoid hemorrhage (SAH). Using the recently developed Subarachnoid Hemorrhage Early Brain Edema Score (SEBES), we analyzed the predictors of early brain edema and its impact on the complications related to intracranial pressure (ICP) increase after SAH.

Methods: All consecutive cases with SAH treated between 01/2003 and 06/2016 with available pre-treatment imaging (<72h after ictus) enabling the SEBES assessment were included (n=698). The data on demographic characteristics, previous medical history, common features of SAH, need for conservative ICP treatment and decompressive craniectomy, cerebral infarcts, in-hospital mortality and unfavorable outcome at 6 months (mRS>3) were collected from the institutional database.

Results: The mean SEBES value of the cohort was 2.51 points (±1.4). Of eleven pre-SAH parameters with significant results in the univariate analysis, only higher age (UC=-0.04 per-year-of-age-increase, p<0.0001) and presence of hyperuricemia (UC=-0.68, p=0.038) were inversely associated with the SEBES in the final multivariate analysis. In turn, the SEBES was independently associated with the need for conservative ICP treatment (aOR=1.38 per point-increase, p<0.0001) and decompressive craniectomy (aOR=1.68, p<0.0001) during SAH, as well as with the risk of cerebral infarcts (aOR=1.26, p=0.001), in-hospital mortality (aOR=1.25, p=0.02) and unfavorable outcome at 6 months (aOR=1.33, p=0.001). According to the receiver operating characteristic analysis, the clinically relevant cutoff for the SEBES for the association with the study endpoints was ³3 points.

Conclusion: Early brain edema on the admission computed tomography scan is a reliable marker of further ICP-related complications and poor outcome of SAH. Older individuals and those with hyperuricemia seem to be less prone to severe early brain edema after SAH.