The Fisher Grade in predicting a degree of cerebral vasospasm in patients after intracranial aneurysm rupture

Đilvesi, Đula; Cigić, Tomislav; Papić, Vladimir; Horvat, Igor; Karan, Mladen; Vuleković, Petar

doi:10.2298/vsp140927021d

Cited by 3 publications

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“…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]. 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].…”

Section: Discussionsupporting

confidence: 90%

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

2019

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Objectives: Recent guidelines recommend early closure of the ruptured aneurysms. However, this may not be available in all cases especially in developing countries. This may lead to late surgery during the period of vasospasm which may carry a potential surgical risk. The aim of this study is to report our experience of microsurgical clipping during the period of vasospasm for ruptured anterior circulation aneurysms. Methods: This study included 36 patients with ruptured anterior circulation aneurysms treated with microsurgical clipping "between January 2014 and December 2016". All patients were operated during the period of vasospasm. We retrospectively reviewed our medical files for any operative complications, any evidence for clinical vasospasm and postoperative ischemia, and for the patients outcome. Results: Majority of patients were in good World Federation of Neurosurgeons (WFNS) Grades. Thirty (83.3%) were grades I-III. All the procedures completed successfully except in three patients who had an intraoperative rupture. Clinical vasospasm was reported in 8 (22.2%) of the patients. Favorable outcome was reported in 31 (86.1%) patients. We had only one (2.8%) perioperative mortality from aggravated vasospasm. Conclusions: Microsurgical clipping of the ruptured anterior circulation aneurysms can be done safely during the period of vasospasm without devastating complications. Securing the aneurysm in patients with late referral in developing countries should be done to prevent rebleeding and to allow for the 3H therapy application safely.

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Section: Discussionsupporting

confidence: 90%

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

2019

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“…Furthermore, in multivariate logistic regression models of finding predictors of SCV, Lp-PLA2 level was an independent and significant predictor after adjustment for confounders, including the WFNS grade, diabetes mellitus, and aneurysm size. Currently, among all grading schemes, the modified Fisher grade and the WFNS grade are the most widely used, because of their relatively strong predictive power and ease of use [ 4 – 6 ]. It was found that for SCV patients, the predictive performance of Lp-PLA2 was comparable with the WFNS grade and modified Fisher grade, which indicates the potential of the Lp-PLA2 level as a new marker in aSAH prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…The clinical grading schemes for assessing severity of aSAH and interpretation of CT scans, such as the WFNS grade and modified Fisher grade [ 4 – 6 ], are often used to predict occurrence of CV. However, identification of more easily measurable biomarkers for predicting CV would still be helpful for prognosis and risk mitigation.…”

Section: Discussionmentioning

confidence: 99%

“…To overcome this disadvantage, a number of alternative grading schemes have been proposed. However, each scheme is associated with certain limitations [6][7][8][9][10][11]. Currently, there is still an unmet need for reliable biomarkers that could be used for more effective diagnosis and assessment of aSAH [12][13][14] in the clinical setting.…”

Section: Introductionmentioning

confidence: 99%

“…Currently, clinical rating scales such as the World Federation of Neurosurgical Societies (WFNS) grade and modified Fisher grade, which are easy to use and have relatively high predictive power, are used for assessing the performance of neurological functions and predicting the occurrence of CV [ 4 – 6 ]. However, these clinical scales are not able to differentiate the physical condition of a patient when the changes are small.…”

Section: Introductionmentioning

confidence: 99%

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Can admission lipoprotein-associated phospholipase A2 predict the symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage?

et al. 2020

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Background: Inflammation has been believed to be related to the development of cerebral vasospasm following aneurysmal subarachnoid hemorrhage (aSAH). A potential biomarker for vascular inflammation that is well recognized is the lipoprotein-associated phospholipase A2 (Lp-PLA2). However, whether Lp-PLA2 can predict the occurrence of symptomatic cerebral vasospasm (SCV) in aSAH patients is still unknown. Thus, this study aimed to assess the value of Lp-PLA2 for predicting SCV in patients with aSAH. Methods: Between March 2017 and April 2018, we evaluated 128 consecutive aSAH patients who were admitted in the First Affiliated Hospital of Fujian Medical University. Their Lp-PLA2 level was obtained within 24 h of the initial bleeding. Factors might be related to SCV were analyzed. Results: Compared to patients without SCV, those with SCV (9.4%, 12/128) had significantly higher Lp-PLA2 level. Multivariate logistic analysis revealed that worse modified Fisher grade (OR = 10.08, 95% CI = 2.04-49.86, P = 0.005) and higher Lp-PLA2 level (OR = 6.66, 95% CI = 1.33-3.30, P = 0.021) were significantly associated with SCV, even after adjustment for confounders. Based on the best threshold, Lp-PLA2 had a sensitivity of 83.3% and a specificity of 51.7% for predicting SCV, as shown by the receiver operating characteristic curve analysis. In the poor World Federation of Neurosurgical Societies grade patient subgroup , patients with Lp-PLA2 > 200 μg/L had significantly higher SCV rate than that of patients having Lp-PLA2 ≤ 200 μg/L. Conclusion: The admission Lp-PLA2 level might be a helpful predictor for SCV in aSAH.

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Is Admission Lipoprotein-Associated Phospholipase A2 a Novel Predictor of Vasospasm and Outcome in Patients With Aneurysmal Subarachnoid Hemorrhage?

Ding

Cai

et al. 2019

Neurosurg.

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BACKGROUND The relationships between lipoprotein-associated phospholipase A2 (Lp-PLA2) level, vasospasm, and clinical outcome of patients with aneurysmal subarachnoid hemorrhage (aSAH) are still unclear. OBJECTIVE To identify the associations between admission Lp-PLA2 and vasospasm following subarachnoid hemorrhage and the clinical outcome of aSAH. METHODS A total of 103 aSAH patients who had Lp-PLA2 level obtained within 24 h postbleeding were included. The relationships between Lp-PLA2 level, vasospasm, and clinical outcome were analyzed. RESULTS Vasospasm was observed in 52 patients (50.49%). Patients with vasospasm had significantly higher Lp-PLA2 level than those without (P < .001). Both modified Fisher grade (P = .014) and Lp-PLA2 level (P < .001) were significant predictors associated with vasospasm. The Z test revealed that power of Lp-PLA2 was significantly higher than that of modified Fisher grade in predicting vasospasm (Z = 2.499, P = .012). At 6-mo follow-up, 44 patients (42.72%) had unfavorable outcome and 36 patients (34.95%) died. The World Federation of Neurosurgical Societies (WFNS) grade and Lp-PLA2 level were both significant predictors associated with 6-mo unfavorable outcome and mortality (all P < .001). The predictive values of Lp-PLA2 for unfavorable outcome and mortality at 6-mo tended to be lower than those of the WFNS grade, but the differences were not statistically significant (P = .366 and 0.115, respectively). Poor-grade patients having Lp-PLA2 > 200 μg/L had significantly worse 6-mo survival rate than poor-grade patients having Lp-PLA2 ≤ 200 μg/L (P = .001). CONCLUSION The Lp-PLA2 might be useful as a novel predictor in aSAH patients. A total of 30 poor-grade patients; those with elevated Lp-PLA2 level have higher risk of 6-mo mortality compared to those without.

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The Fisher Grade in predicting a degree of cerebral vasospasm in patients after intracranial aneurysm rupture

Abstract: This study showed that the Fisher Grade is not significant in predicting the intensity of cerebral vasospasm in patients hospitalized with intracranial aneurysm rupture.

Cited by 3 publications

References 0 publications

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

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

Can admission lipoprotein-associated phospholipase A2 predict the symptomatic cerebral vasospasm following aneurysmal subarachnoid hemorrhage?

Is Admission Lipoprotein-Associated Phospholipase A2 a Novel Predictor of Vasospasm and Outcome in Patients With Aneurysmal Subarachnoid Hemorrhage?

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