Abstract

Background

It is known that patients suffering poor-grade aneurysmal subarachnoid hemorrhage (aSAH) have a dismal prognosis. The importance of early intervention is well established in the pertinent literature. Our aim was to assess the functional outcome and overall survival of these patients undergoing surgical clipping.

Material and methods

In the current retrospective study we included all consecutive poor-grade patients after spontaneous SAH who presented at our institution over an eight-year period. All participants suffering SAH underwent brain CT angiography (CTA) to identify the source of hemorrhage. We assessed the severity of hemorrhage according to the Fisher grade classification scale. All patients were surgically treated. The functional outcome was evaluated six months after the onset with the Glasgow Outcome Scale. Finally, we performed logistic and Cox regression analyses to identify potential prognostic risk factors.

Results

Our study included twenty-three patients with a mean age of 53 years. Five (22%) patients presented with Hunt and Hess grade IV, and eighteen (78%) with grade V. The mean follow-up was 15.8 months, while the overall mortality rate was 48%. The six-month functional outcome was favorable in 6 (26%) patients. The vast majority of our patients died between the 15^th and the 60^th post-ictal days. We did not identify any statistically significant prognostic factors related to the patient’s outcome and/or survival.

Conclusions

Poor-grade aSAH patients may have a favorable outcome with proper surgical management. Large-scale studies are necessary for accurately outlining the prognosis of this entity, and identifying parameters that could be predictive of outcome.

中文翻译：

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轻度动脉瘤性蛛网膜下腔出血患者的中期手术结果。单一中心体验

摘要

背景

众所周知，患有严重动脉瘤性蛛网膜下腔出血 (aSAH) 的患者预后不佳。早期干预的重要性在相关文献中得到了很好的证实。我们的目的是评估这些接受手术夹闭的患者的功能结果和总生存期。

材料与方法

在当前的回顾性研究中，我们纳入了自发性 SAH 后连续八年在我们机构就诊的所有低级别患者。所有患有 SAH 的参与者都接受了脑 CT 血管造影 (CTA) 以确定出血的来源。我们根据 Fisher 分级分类量表评估了出血的严重程度。所有患者均接受了手术治疗。使用格拉斯哥结果量表在发病六个月后评估功能结果。最后，我们进行了逻辑和 Cox 回归分析，以确定潜在的预后风险因素。

结果

我们的研究包括 23 名平均年龄为 53 岁的患者。5 名 (22%) 患者出现 Hunt 和 Hess IV 级，18 名 (78%) 患者出现 V 级。平均随访时间为 15.8 个月，总死亡率为 48%。6 名 (26%) 患者的 6 个月功能结果良好。我们的绝大多数患者在发作后第 15^天到第60天之间死亡。我们没有发现任何与患者结局和/或生存期相关的具有统计学意义的预后因素。

结论

通过适当的手术治疗，低级别 aSAH 患者可能会获得良好的结果。大规模研究对于准确概述该实体的预后并确定可预测结果的参数是必要的。