Title:Length of Survival, Outcome, and Potential Predictors in Poor-Grade
Aneurysmal Subarachnoid Hemorrhage Patients Treated with
Microsurgical Clipping
Volume: 23
Issue: 9
Author(s): Xanthoula Lambrianou*, Christos Tzerefos, Christina Arvaniti, Anastasia Tasiou and Kostas N. Fountas
Affiliation:
- Department of Neurosurgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences,
University of Thessaly, Larissa, Greece
Keywords:
Cerebral aneurysm, clipping, functional outcome, hunt and hess grade, length of survival, subarachnoid hemorrhage.
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.
