Risks factors for cerebral infarction in good-grade patients after aneurysmal subarachnoid hemorrhage and surgery: a prospective study

Öhman, Juha; Servo, Antti; Heiskanen, O

doi:10.3171/jns.1991.74.1.0014

Cited by 111 publications

(65 citation statements)

References 37 publications

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“…The timing of surgery is not associated with the outcome or have a relatively small influence on the outcome (14,20,29). There was no significant difference between incidences of cerebral infarcts in patients who underwent emergent surgery (22).…”

Section: Operation Stagementioning

confidence: 98%

“…Disney et al (7) reported that initial systolic blood pressure had relative importance as a prognostic factor in outcomes, although other authors claim that a history of essential arterial hypertension is not related to outcome (11,14,20). In the study by Ohman et al (22) a history of hypertension was reported to be a prognostic factor for cerebral infarction in patients after aneurysmal SAH.…”

Section: Risk Factorsmentioning

confidence: 99%

“…The amount of blood in the subarachnoid space is closely related to the occurrence of vasospasms. The thickness of blood clots identified during CT scans can be considered a good predictor of outcome (22,25,27). Fisher grade, intracranial hematoma volume and amount of intraventricular hemorrhage have all been related to poor outcomes (18).…”

Section: Fisher Gradementioning

confidence: 99%

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

Orakdogen

Emon²,

Somay³

et al. 2015

Turkish Neurosurgery

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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.

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Section: Operation Stagementioning

confidence: 98%

Section: Risk Factorsmentioning

confidence: 99%

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

Orakdogen

Emon²,

Somay³

et al. 2015

Turkish Neurosurgery

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“…First, treatment with nimodipine and hemodynamic maneuvers may have decreased the risk of delayed cerebral ischemia. Despite widespread opinion to the contrary, nimodipine may reduce angiographic vasospasm 40,41 and cerebral infarction. 44,47 The increasing use of endovascular treatment of aneurysms and the decreasing use of invasive arteriography in favor of less invasive alternatives (CT or magnetic resonance angiography) may also alter the incidence and severity of angiographic vasospasm after SAH.…”

Section: Does Sah Cause Vasospasm?mentioning

confidence: 99%

Can angiographic vasospasm be used as a surrogate marker in evaluating therapeutic interventions for cerebral vasospasm?

Nolan

Macdonald²

2006

FOC

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✓ The authors tested the null hypothesis that published literature with a high level of evidence does not support the assertion that subarachnoid hemorrhage (SAH) causes cerebral vasospasm, which in turn causes cerebral infarction and poor outcome after aneurysmal SAH. The medical literature on SAH was searched in MEDLINE. The author's personal files of all published literature on SAH were reviewed. References cited in Cochrane reviews as well as the published papers that were reviewed were also retrieved. There is no question that SAH causes what the authors have chosen to call “angiographic vasospasm.” However, the incidence and severity of vasospasm in recent series of patients is not well defined. There is reasonable evidence that vasospasm causes infarction, but again, accurate data on how severe and how diffuse vasospasm has to be to cause infarction and how often vasospasm is the primary cause of infarction are not available. There are good data on the incidence of cerebral infarction after SAH, and these data indicate that it is highly associated with poor outcome. The link between angiographic vasospasm and poor outcome is particularly poorly described in terms of what would be considered data of a high level of evidence. The question as to whether there is a clear pathway from SAH to vasospasm to cerebral infarction to poor outcome seems so obvious to neurosurgeons as to make it one not worth asking. Nevertheless, the obvious is not always true or accurate, so it is important to note that published literature only weakly supports the causative association of vasospasm with infarction and poor outcome after SAH. It behooves neurosurgeons to document this seemingly straightforward pathway with high-quality evidence acceptable to the proponents of evidence-based medicine.

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“…The criteria to consider patients as high risk for CVS included severity of clinical findings (WFNS [17] grades 3-5, Hunt and Hess [18] grades II -V) [19][20][21], volume of blood in the cisterns and ventricles (Fisher grades 3 and 4) [22], signs of rebleeding prior to treatment [23], young age [24], nicotine consumption [25], cocaine abuse [26,27], hypertension [28,29], and hyperglycemia [29]. Gender was not considered as risk factor for CVS in this study [30].…”

Section: Patient Population and Treatment Protocolmentioning

confidence: 99%

Incidence of Vasospasm, Outcome, and Quality of Life after Endovascular and Surgical Treatment of Ruptured Intracranial Aneurysms: Results of a Single-Center Prospective Study in Switzerland

Hofmann

Marbacher

Jakob

et al. 2011

ISRN Vascular Medicine

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Background. Outcome after endovascular versus surgical treatment of ruptured aneurysms is still controversial. The aim of this study was to analyze the incidence of cerebral vasospasm (CVS), outcome, and quality of life in patients undergoing endovascular or surgical treatment. Methods. This single-center prospective study included all patients undergoing aneurysm occlusion over a one-year period. All patients underwent postinterventional CT scan, TCD, and angiography on day 9 ± 2 . Outcome (Barthel Index, NIHSS, mRS, MMSE) was evaluated at 6 and 12 weeks. Quality of life (EuroQoL, SF-12) was assessed at 6 months. Results. A total of 66 patients were included. The overall mortality due to CVS was 9.9%, and higher in the surgical (14.6%) than in the endovascular group (4%). The incidence of symptomatic (29.2% versus 24%) and angiographic (70.7% versus 52%) CVS was not statistically significant different between the two groups. No differences in outcome or quality of life (SF-12) could be demonstrated. Conclusions. The outcome and quality of life of patients undergoing endovascular or surgical treatment seems not to significantly differ if demographic, radiological, and intensive care parameters are similar. A trend toward lower incidence of CVS in patients undergoing endovascular treatment was observed.

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Risks factors for cerebral infarction in good-grade patients after aneurysmal subarachnoid hemorrhage and surgery: a prospective study

Cited by 111 publications

References 37 publications

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

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

Can angiographic vasospasm be used as a surrogate marker in evaluating therapeutic interventions for cerebral vasospasm?

Incidence of Vasospasm, Outcome, and Quality of Life after Endovascular and Surgical Treatment of Ruptured Intracranial Aneurysms: Results of a Single-Center Prospective Study in Switzerland

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