Acta Neurochirurgica

, Volume 159, Issue 3, pp 559–565

Causes of poor outcome in patients admitted with good-grade subarachnoid haemorrhage

  • Vladimír Beneš3rd
  • Lubomír Jurák
  • Radim Brabec
  • Nina Nechanická
  • Miroslav Šercl
  • Ladislav Endrych
  • Pavel Buchvald
  • Petr Suchomel
Original Article - Vascular

DOI: 10.1007/s00701-017-3081-8

Cite this article as:
Beneš, V., Jurák, L., Brabec, R. et al. Acta Neurochir (2017) 159: 559. doi:10.1007/s00701-017-3081-8
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Abstract

Background

Surgical risk in patients with unruptured aneurysms is well known. The relative impact of surgery and natural history of subarachnoid haemorrhage (SAH) on patients in good clinical condition (World Federation of Neurological Surgeons [WFNS] grades 1 and 2) is less well quantified. The aim of this study was to determine causes of poor outcome in patients admitted in good grade SAH.

Methods

A retrospective study of prospectively collected data among WFNS-1 and -2 patients: demographics, SAH and aneurysm-related data, surgical complications and outcome as assesed by the Glasgow Outcome Scale (GOS). Causes of poor outcome (GOS 1–3) were determined.

Results

During a 7-year period (2009–15), 56 patients with SAH WFNS-1 (39 patients) or WFNS-2 (17 patients) were treated surgically (21 men, 35 women; mean age, 52.4 years). According to the Fisher scale, 19 patients were grade 1 or 2; 37 patients were grade 3 or 4. Most aneurysms were located at anterior communicating (26) or middle cerebral (15) artery.

Altogether, 11 patients (19.6%) achieved GOS 1–3. This was attributed to SAH-related complications in six patients (rebleeding, vasospasm), surgery in four patients (postoperative ischaemia in two, haematoma and ventriculitis in one patient each), grand-mal seizure with aspiration in one patient. Age over 60 years (p = 0.017) and presence of hydrocephalus (p < 0.001) were statistically significant predictors of poor GOS; other variables (e.g. sex, Fisher grade, aneurysm size or location, use of temporary clips, intraoperative rupture, vasospasm) were not significant.

Conclusions

Patients admitted in good-grade SAH achieve favourable outcome following surgical aneurysm repair in the majority of cases. Negative factors include age over 60 years and presence of hydrocephalus. Aneurysm surgery following good-grade SAH still carries a small but significant risk similar to that shown in large multi-institutional trials.

Keywords

Subarachnoid haemorrhageAneurysmOutcomeSurgical complication

Copyright information

© Springer-Verlag Wien 2017

Authors and Affiliations

  • Vladimír Beneš3rd
    • 1
  • Lubomír Jurák
    • 1
  • Radim Brabec
    • 1
  • Nina Nechanická
    • 1
  • Miroslav Šercl
    • 2
  • Ladislav Endrych
    • 2
  • Pavel Buchvald
    • 1
  • Petr Suchomel
    • 1
  1. 1.Department of NeurosurgeryRegional Hospital LiberecLiberecCzech Republic
  2. 2.Department of RadiologyRegional Hospital LiberecLiberecCzech Republic