Length of Survival, Outcome, and Potential Predictors in Poor-Grade Aneurysmal Subarachnoid Hemorrhage Patients Treated with Microsurgical Clipping

Xanthoula Lambrianou; Christos Tzerefos; Christina Arvaniti; Anastasia Tasiou; Kostas N Fountas

doi:10.2174/0118715273258678231011060312

Length of Survival, Outcome, and Potential Predictors in Poor-Grade Aneurysmal Subarachnoid Hemorrhage Patients Treated with Microsurgical Clipping

CNS Neurol Disord Drug Targets. 2023 Oct 19. doi: 10.2174/0118715273258678231011060312. Online ahead of print.

Authors

Xanthoula Lambrianou¹, Christos Tzerefos¹, Christina Arvaniti¹, Anastasia Tasiou¹, Kostas N Fountas¹

Affiliation

¹ Department of Neurosurgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.

PMID: 37855362
DOI: 10.2174/0118715273258678231011060312

Abstract

Background: Poor-grade aneurysmal subarachnoid hemorrhage (aSAH) has been associated with severe morbidity and high mortality. It has been demonstrated that early intervention is of paramount importance. The aim of our study is to evaluate the functional outcome and the overall survival of early microsurgically treated patients.

Material and methods: Poor-grade aSAH patients admitted at our institution over fifteen years (January 2008 - December 2022) were included in our retrospective study. All participants underwent brain Computed Tomography Angiography (CTA). Fisher scale was used to assess the severity of hemorrhage. All our study participants underwent microsurgical clipping, and their functional outcome was assessed with the Glasgow Outcome Scale (GOS). We used logistic regression analysis to identify any parameters associated with a favorable outcome at 12 months. Cox proportional hazard analysis was also performed, identifying factors affecting the length of survival.

Results: Our study included 39 patients with a mean age of 54 years. Thirty of our participants (76.9%) were Hunt and Hess grade V, while the vast majority (94.9%) were Fisher grade 4. The observed six-month mortality rate was 48.6%. The mean follow-up time was 18.6 months. The functional outcome at six months was favorable in 6 patients (16.2%), increased to 23.5% at 12 months. Our data analysis showed that the age, as well as the employment of temporary clipping during surgery, affected the overall outcome.

Conclusion: Management of poor-grade aSAH patients has been dramatically changed. Microsurgical clipping provides promising results in carefully selected younger patients.

Keywords: Cerebral aneurysm; clipping; functional outcome; hunt and hess grade; length of survival; subarachnoid hemorrhage.