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Subarachnoid haemorrhage WFNS grade V: is maximal treatment worthwhile?

  • Clinical Article - Vascular
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Abstract

Background

Aneurysmal subarachnoid haemorrhage (SAH) WFNS grade V is commonly known to be associated with high mortality and a very poor prognosis for survivors. Therefore, maximal invasive therapy is frequently delayed until any spontaneous improvement with or without an external ventricular drainage occurs. The aim of the study was to verify possible predictive factors and the probability of a favourable outcome in maximally treated patients.

Methods

One hundred and thirty-eight consecutive patients with WFNS grade V SAH were admitted between 03/2006 and 12/2010. Thirty-five patients died before aggressive therapy could proceed. One hundred and three patients received maximal treatment and were retrospectively evaluated. The outcome was assessed at discharge and in the follow-up with the Glasgow Outcome Scale. Univariate and multivariate linear regression models were performed to find predictors for an unfavourable outcome.

Results

Despite treatment, early mortality was 30 % (n = 31). At discharge, the rate of both vegetative and severely disabled patients was 27 % (n = 28). Favourable outcome at discharge was observed in 16 % (n = 16) of cases, whereas in the follow-up it rose to 26 % (n = 27). Multivariate full model regression identified intraventricular haematoma (IVH) and increasing age as independently predictive for poor outcome.

Conclusions

Despite treatment, initial mortality and severe disability remain high. Nevertheless, a favourable outcome was achieved in 26 % of aggressively treated patients, rendering the withdrawal of maximal therapy for WFNS grade V SAH patients unacceptable today. In cases of old patients with IVH, the indication for aggressive therapy should be put in place more carefully due to a very poor prognosis.

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Author notes

  1. Michael Stoffel

    Present address: Department of Neurosurgery, Helios Kliiniken Krefeld, Krefeld, Germany

Authors and Affiliations

  1. Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, 81675, Munich, Germany

    Maria Wostrack, Kathrin Harmening, Florian Ringel, Yu-Mi Ryang, Benjamin Friedrich, Michael Stoffel & Bernhard Meyer

  2. Department of Neurosurgery, Charité University, Berlin, Germany

    Nora Sandow & Peter Vajkoczy

  3. Department of Neurosurgery, University of Geneva Medical Center, Geneva, Switzerland

    Bawarjan Schatlo, Philippe Bijlenga & Karl Schaller

  4. Institute for Medical Statistics and Epidemiology, Technical University of Munich, Munich, Germany

    Victoria Kehl

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  1. Maria Wostrack
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  2. Nora Sandow
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Correspondence to Maria Wostrack.

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Wostrack, M., Sandow, N., Vajkoczy, P. et al. Subarachnoid haemorrhage WFNS grade V: is maximal treatment worthwhile?. Acta Neurochir 155, 579–586 (2013). https://doi.org/10.1007/s00701-013-1634-z

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  • DOI: https://doi.org/10.1007/s00701-013-1634-z

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