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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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Early surgery in patients suffering poor-grade aneurysmal subarachnoid haemorrhage – a single institution experience

Frühchirurgische Eingriffe bei Patienten mit minderwertigen aneurysmatischen Subarachnoidalblutungen: Erfahrung in einzige Einrichtung

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  • presenting/speaker Xanthoula Lambrianou - University Hospital of Larissa, Neurosurgery Department, Larissa, Griechenland
  • Anastasia Tasiou - University Hospital of Larissa, Neurosurgery Department, Larissa, Griechenland
  • Christos Tzerefos - University Hospital of Larissa, Neurosurgery Department, Larissa, Griechenland
  • Alkiviadis Tzannis - University Hospital of Larissa, Neurosurgery Department, Larissa, Griechenland
  • Adamantios Kalogeras - University Hospital of Larissa, Neurosurgery Department, Larissa, Griechenland
  • Maria Karagianni - University Hospital of Larissa, Neurosurgery Department, Larissa, Griechenland
  • Theodosios Spiliotopoulos - University Hospital of Larissa, Neurosurgery Department, Larissa, Griechenland
  • George Fotakopoulos - University Hospital of Larissa, Neurosurgery Department, Larissa, Griechenland
  • Kostas N. Fountas - University Hospital of Larissa, Neurosurgery Department, Larissa, Griechenland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocJ-HSNC05

doi: 10.3205/22dgnc488, urn:nbn:de:0183-22dgnc4886

Published: May 25, 2022

© 2022 Lambrianou 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: It is well known that rupture of an intracranial aneurysm constitutes the most common cause of spontaneous subarachnoid hemorrhage (sSAH). Poor-grade aneurysmal SAH (aSAH) patients are characterized by increased morbidity and mortality. In our current communication, we present our results regarding the outcome of poor-aSAH patients.

Methods: Fifty-one patients (26M and 25F) were included in our retrospective study (January 2009 - October 2021). Patients were divided into two groups: Group A with good Hunt & Hess grade (33.3%), and Group B with poor grade (66.6%). The mean age was 55.8 years (range 25-75). All participants with CT-established diagnosis of sSAH, underwent CT angiography for identification of the source of hemorrhage. The severity of sSAH was assessed with the Fisher scale. Digital subtraction angiography was performed in limited number of patients (13.7%). All patients suffering poor aSAH, were surgically treated. Their clinical outcome was evaluated by applying the Glasgow Outcome Scale (GOS). Our mean follow-up time was 20.4 months (range 2-144).

Results: Poor-grade patients (H-H grade IV, or V) were 34 (66.6%). Twenty-eight of these patients (54.9%) were surgically treated within 24h postictus. Twenty-seven out of them were Fisher grade 4 (96.4%). Overall, the six-month postoperative outcome in poor aSAH group was favorable (GOS 4 or 5) in 15 patients (44.1%), while an unfavorable outcome occurred in 19 (55.9%). The mortality rate in poor aSAH group was 47% (16 patients). The most common cause of death was septicemia.

Conclusion: It is widely accepted that severe aSAH constitutes a devastating disease. However, our current data indicate that even poor-grade patients may achieve favorable outcome with early operative intervention. A larger volume series is necessary for accurately outlining the prognosis of patients suffering poor aSAH, and also for identifying those parameters, which could predict good outcome with early surgical intervention.