Age limit for surgical treatment of poor-grade patients with subarachnoid hemorrhage: A project of the Chugoku-Shikoku division of the Japan neurosurgical society

Shirao, Satoshi; Yanagawa, Hiroshi; Kunitsugu, Ichiro; Suehiro, Eiichi; Koizumi, Hiroyasu; Suzuki, Michiyasu

doi:10.4103/2152-7806.103886

Cited by 13 publications

(5 citation statements)

References 26 publications

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“…Future work will be directed towards elucidating the mechanisms of neurological improvement upon relatively delayed ROCK inhibition after a CC lesion and determine whether they overlap with previously demonstrated effects in other forms of central nervous system injury, such as reduced inflammation, blood-brain barrier disruption, and glial scar formation, and enhanced axonal sprouting, neurogenesis, and remyelination. Given that fasudil is already in clinical use in the Far East, 38 clinical translation of our findings might be swift, if confirmed independently.…”

Section: Discussionsupporting

confidence: 53%

Rho-Kinase Inhibition Improves the Outcome of Focal Subcortical White Matter Lesions

Aykan

Xie

Zheng

et al. 2022

Stroke

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Background: Subcortical white matter lesions are exceedingly common in cerebral small vessel disease and lead to significant cumulative disability without an available treatment. Here, we tested a rho-kinase inhibitor on functional recovery after focal white matter injury. Methods: A focal corpus callosum lesion was induced by stereotactic injection of N 5 -(1-iminoethyl)-L-ornithine in mice. Fasudil (10 mg/kg) or vehicle was administered daily for 2 weeks, starting one day after lesion induction. Resting-state functional connectivity and grid walk performance were studied longitudinally, and lesion volumes were determined at one month. Results: Resting-state interhemispheric functional connectivity significantly recovered between days 1 and 14 in the fasudil group ( P <0.001), despite worse initial connectivity loss than vehicle before treatment onset. Grid walk test revealed an increased number of foot faults in the vehicle group compared with baseline, which persisted for at least 4 weeks. In contrast, the fasudil arm did not show an increase in foot faults and had smaller lesions at 4 weeks. Immunohistochemical examination of reactive astrocytosis, synaptic density, and mature oligodendrocytes did not reveal a significant difference between treatment arms. Conclusions: These data show that delayed fasudil posttreatment improves functional outcomes after a focal subcortical white matter lesion in mice. Future work will aim to elucidate the mechanisms.

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Section: Discussionsupporting

confidence: 53%

Rho-Kinase Inhibition Improves the Outcome of Focal Subcortical White Matter Lesions

Aykan

Xie

Zheng

et al. 2022

Stroke

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“…This finding is similar to early studies. 35–37 40 IVH was significantly associated with poor outcome. IVH may probably cause irreversible periventricular brain damage.…”

Section: Discussionmentioning

confidence: 90%

Factors and outcomes associated with ultra-early surgery for poor-grade aneurysmal subarachnoid haemorrhage: a multicentre retrospective analysis

Zhao

Tan

et al. 2015

BMJ Open

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ObjectiveTo determine factors and outcomes associated with ultra-early surgery for poor-grade aneurysmal subarachnoid haemorrhage (aSAH).DesignA multicentre retrospective analysis, observational study.SettingHigh-volume teaching hospitals (more than 150 aSAH cases per year).Participants118 patients with World Federation of Neurosurgical Societies (WFNS) grades IV and V underwent surgical treatment. Ultra-early surgery was defined as surgery performed within 24 h of aSAH, and delayed surgery as surgery performed after 24 h. Outcome was assessed by modified Rankin Scale (mRS). The mean time of follow-up was 12.5±3.4 months (range 6–28 months).Results47 (40%) patients underwent ultra-early surgery, and 71 (60%) patients underwent delayed surgery. Patients with WFNS grade V (p=0.011) and brain herniation (p=0.004) more often underwent ultra-early surgery. Postoperative complications were similar in ultra-early and delayed surgery groups. Adjusted multivariate analysis showed the outcomes were similar between the two groups. Multivariate analysis of predictors of poor outcome, ultraearly surgery was not an independent predictor of poor outcome, while advanced age, postresuscitation WFNS V grade, intraventricular haemorrhage, brain herniation and non-middle cerebral artery (MCA) aneurysms were associated with poor outcome.ConclusionsAlthough patients with WFNS grade V and brain herniation more often undergo ultra-early surgery, postoperative complications and outcomes in selected patients were similar in the two groups. Patients of younger age, WFNS grade IV, absence of intraventricular haemorrhage, absence of brain herniation and MCA aneurysms are more likely to have a good outcome. Ultra-early surgery could improve outcomes in carefully selected patients with poor-grade aSAH.

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“…This was due to the fact that several studies have indicated that clinical outcome was significantly different when the cut-off age was set at 75 years. 8 – 10) There have been no studies showing an age lower than 75 year old could be a cut-off point. We believe that 75 years of age should be considered “elderly” for aSAH when proper treatment is discussed in order to improve outcome.…”

Section: Discussionmentioning

confidence: 99%

“… 4 – 7) In particular, several studies indicat that poor outcome significantly increases in the patients over age 75. 8 – 10) …”

Section: Introductionmentioning

confidence: 99%

Aneurysmal Subarachnoid Hemorrhage in the Elderly over Age 75: A Systematic Review

Ohkuma

Shimamura

Naraoka

et al. 2017

Neurol. Med. Chir.(Tokyo)

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The number of elderly patients with an aneurysmal subarachnoid hemorrhage (aSAH) has been increasing in aging- or aged societies in many countries. A treatment strategy for the elderly with aSAH has not been established, although many studies have been published emphasizing poor outcome for aSAH. The aim of this study was to analyze the factors and treatments affecting outcome in aSAH in the elderly in a systematic review of the literature by investigating patients over age 75. A literature search was done for “elderly aSAH” in PubMed and Embase. Literature with a clear description of treatment measures for aneurysmal occlusion and outcome was selected. Twelve studies, consisted of 816 cases, met the eligibility criteria. Patient characteristics included 83.2% female, 33.8% poor clinical grade on admission, 57.1% Fischer group 3, and 41% internal carotid artery aneurysm. As complications, symptomatic vasospasm was seen in 25.5% of patients, hydrocephalus in 31.1%, and medical complication in 38.4%. Favorable outcome was 35.0% in total, 45.3% for clipping, 36.3% for coiling, and 9.0% for conservative treatment. Several studies by multivariate analysis indicated that poor clinical grade on admission could be a risk factor for neurological outcome and mortality. Advanced age and selection of conservative treatment without aneurysmal occlusion could be a risk factor for mortality. Patients under age 85 with good clinical grade on admission can be candidates for treatment of aneurysm repair. However, treatment for patients over age 85 or with poor clinical grade should be carefully determined.

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Age limit for surgical treatment of poor-grade patients with subarachnoid hemorrhage: A project of the Chugoku-Shikoku division of the Japan neurosurgical society

Cited by 13 publications

References 26 publications

Rho-Kinase Inhibition Improves the Outcome of Focal Subcortical White Matter Lesions

Rho-Kinase Inhibition Improves the Outcome of Focal Subcortical White Matter Lesions

Factors and outcomes associated with ultra-early surgery for poor-grade aneurysmal subarachnoid haemorrhage: a multicentre retrospective analysis

Aneurysmal Subarachnoid Hemorrhage in the Elderly over Age 75: A Systematic Review

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