Prognostic factors in patients underwent aneurysmal clipping surgery due to spontaneous subarachnoid hemorrhage

Abstract

ABSTRACTaneurysmal SAHs have been investigated in several studies.The aim of the present retrospective study is to examine the various prognostic factors of the clinical outcomes of 104 patients who underwent a neurosurgical clipping of aneurysms due to aneurysmal SAH between 2008 and 2014. █ mATERIAl and mEThODSThe data of 104 patients that had suffered an aneurysmal SAH were analyzed. The patients were recruited between 2008 and 2014 at the Neurosurgery Clinic of Haydarpasa Numune Training and Research Hospital. █ INTRODUCTION D espite the technical and medical advances, aneurysmal subarachnoid hemorrhage (SAH) continue to be a challenging pathology, associated with high rates of morbidity and mortality. The current treatment of the condition involves the early repair of the aneurysm to prevent re-bleeding and associated problems, including cerebral vasospasm, hydrocephalus, electrolyte imbalances, infections and seizures.In this regard, a definition is required of the various prognostic factors of an SAH. The factors affecting the outcomes of AIm: Despite technical and medical advances, aneurysmal subarachnoid hemorrhages (SAH) continue to be a challenging pathology, associated with high rates of morbidity and mortality. In this regard, a definition is required of the various prognostic indicators of an SAH. The aim of the present retrospective study is to examine the various prognostic factors of the clinical outcomes of the patients who underwent a neurosurgical clipping of aneurysms due to aneurysmal SAH. mATERIAl and mEThODS:The data of 104 patients that had suffered an aneurysmal SAH were analyzed. The baseline demographic, clinical and radiological data were all analyzed. The prognostic study was derived from an analysis of these variables. Relationship between prognostic factors and outcome was evaluated by univariate and logistic multivariate regression analysis. RESUlTS:This study has identified unfavorable outcomes on the Glasgow Outcome Scale at discharge after the surgical treatment of aneurysmal SAH associated with increased age, poor World Federation of Neurosurgical Societies (WFNS) grade on admission, higher Fisher's grade on admission computed tomography scan, larger aneurysm, and clinical vasospasm. In a multivariate logistic regression analysis, age, high WFNS grade, positive clinical vasospasm and size of aneurysm were found to be independent risk factors for mortality. The presence of hydrocephalus, number of aneurysms, positive risk factors, and the presence of Doppler vasospasm did not reach statistical significance. CONClUSION:The most important prognostic factors in patients undergoing surgery due to aneurysmal subarachnoid hemorrhage were WFNS grade, age, size of aneurysm and clinical vasospasm.

Outcome of microsurgical clipping of anterior circulation aneurysms during the period of vasospasm: single center experience in Egypt

“…The only significant prognostic factor was in patients with Fisher grade II, and all patients had favorable outcome. This is in agreement with other previously published studies investigating the prognostic factors after microsurgical clipping of cerebral aneurysms [15,17]. A study by Dilvesi et al showed that the Fisher Grade is not significant in predicting the intensity of cerebral vasospasm in patients hospitalized with intracranial aneurysm rupture [21].…”

“…The authors do not recommend postponing treatment in patients between days 5 and 10 after subarachnoid hemorrhage [4]. Orakdogen and others evaluated the timing of surgery with several prognostic factors in patients who underwent microsurgical clipping for ruptured cerebral aneurysms and demonstrated that the rate of mortality was significantly higher in the day 0 period and the rate of mortality did not differ significantly from the other stages of the disease [17]. The aforementioned studies supported the practice of aneurysm treatment once diagnosed even in the period of vasospasm as in our protocol.…”

“…A study by Dilvesi et al showed that the Fisher Grade is not significant in predicting the intensity of cerebral vasospasm in patients hospitalized with intracranial aneurysm rupture [21]. Orakdogen and others reported that WFNS grade, age, size of the aneurysm, and clinical vasospasm were the most important prognostic factors in patients undergoing surgery after rupture of cerebral aneurysms [17]. Bohnstedt et al [8] reported that Hunt and Hess grade on admission was the primary prognostic factor of outcome.…”

3D printing of intracranial aneurysm based on intracranial digital subtraction angiography and its clinical application

“…Furthermore, it was also found that the risk of IPR-associated periprocedural death/disability was 31% with surgical treatment and 63% with endovascular in 2008. [ 4 ] In addition, the mortality of intracranial aneurysm decreased to <14% with neurosurgical treatment [ 5 ] and <1% with endovascular treatment [ 6 ] in 2016. Strengthening the standardized training for residents can effectively reduce medical disputes, self-protect medical staff, and improve medical-patient communication.…”

Riskier-than-expected occlusive treatment of ruptured posterior communicating artery aneurysms: treatment and outcome of 620 consecutive patients

“…The other factors were mainly in line with the detected risk factors for an impaired outcome after aSAH in previous studies. 10,19,22,25,28,34 Aneurysm size was not an independent risk factor for a poor outcome in PCoA aneurysm patients, even though it might be for aneurysms at another location. 22,28 Large or giant PCoA aneurysms were rare, which might affect this result.…”