gms | German Medical Science

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

Correlation of aneurysm morphology with Fisher grade, vasospasm, cerebral infarction and clinical outcome in patients with subarachnoid haemorrhage

Korrelation von Aneurysmamorphologie mit dem Fischer-Grad, Vasospasmen, Hirninfarkten und klinischem Outcome in Patienten mit Subarachnoidalblutung

Meeting Abstract

  • presenting/speaker Lukas Görtz - Universitätsklinikum Köln, Köln, Deutschland
  • Muriel Pflaeging - Universitätsklinikum Köln, Köln, Deutschland
  • Roland Goldbrunner - Universitätsklinikum Köln, Köln, Deutschland
  • Christoph Kabbasch - Universitätsklinikum Köln, Köln, Deutschland
  • Gerrit Brinker - Universitätsklinikum Köln, Köln, Deutschland
  • Boris Krischek - Universitätsklinikum Köln, Köln, 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. DocP162

doi: 10.3205/21dgnc444, urn:nbn:de:0183-21dgnc4445

Published: June 4, 2021

© 2021 Görtz et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objective: Aneurysmal subarachnoid hemorrhage is associated with high morbidity and mortality. In particular, the extent of the initial bleeding, vasospasm and cerebral infarction decisively affect clinical outcome. The aim was to identify specific morphological aneurysm characteristics that could serve as predictive values for aSAH severity, disease-related complications and functional outcome.

Methods: This is a retrospective, single-center analysis of 453 aSAH patients. The morphometric analysis included aneurysm location, dome width, height, neck width, dome-to-neck ratio, aspect ratio, width-to-height ratio, vessel diameter, size ratio, and aneurysm shape. These characteristics were correlated with the following outcome measures using univariate and bivariate logistic regression analyses: World Federation of Neurosurgical Societies (WFNS) grade 4 and 5, Fisher grade 4, vasospasm, cerebral infarction and unfavorable functional outcome (6-month modified Rankin scale score > 2).

Results: The mean aneurysm size was 7.5 ± 3.6 mm and 15% were located at the posterior circulation. An irregular aneurysm shape was seen in 81%. In the multivariate analysis, a wider aneurysm neck was independently associated with Fisher 4 hemorrhage (OR: 1.1, 95% CI: 1.0 – 1.3, p=0.048). Aneurysm dome width (OR: 0.92, 95% CI: 0.86 – 0.97, p=0.005) and internal carotid artery location (OR: 2.1, 95% CI: 1.1 – 4.2, p=0.028) were predictive for the occurrence of vasospasm. None of the analyzed morphological features were independent predictors of functional outcome. Patient age (OR: 0.95, 95% CI: 0.93 – 0.96, p<0.001), WFNS score (OR: 4.8, 95% CI: 2.9 – 8.0, p<0.001), Fisher score (OR: 2.3, 95% CI: 1.4 – 3.7, p<0.001) and cerebral infarction (OR: 4.5, 95% CI: 2.7 – 7.8, p<0.001) were independently associated with unfavorable outcome at 6-month follow-up.

Conclusion: The results showed an independent correlation between aneurysm neck width and Fisher grade and between dome width and internal carotid artery location and vasospasm. However, none of the investigated morphological characteristics were independently associated with cerebral infarction and functional outcome and have thus a limited value as predictor for these outcome measures. In the near future, the occurrence of complications and clinical outcome may be more precisely predicted based on computed tomography angiography with the help of artificial intelligence.