The Factors Associated with Outcomes in Surgically Managed Ruptured Cerebral Aneurysm

Abstract

Failure to diagnose, delay in admission to a neurosurgical centre, and lack of facilities could have led to the poor surgical outcome in these patients. The purpose of this study is to identify the factors that significantly predict the outcome of patients undergoing a surgical clipping of ruptured aneurysm in the local population.Material and Method: A single center retrospective study with a review of medical records was performed involving 105 patients, who were surgically treated for ruptured intracranial aneurysms in the Sultanah Aminah Hospital, in Johor Bahru, from July 2011 to January 2016. Information collected was the patient demographic data, Glasgow Coma Scale (GCS) prior to surgery, World Federation of Neurosurgical Societies Scale (WFNS), subarachnoid hemorrhage (SAH) grading system, and timing between SAH ictus and surgery. A good clinical grade was defined as WFNS grade I-III, whereas, WFNS grades IV and V were considered to be poor grades. The outcomes at discharge and six months post surgery were assessed using the modified Rankin's Scale (mRS). The mRS scores of 0 to 2 were grouped into the "favourable" category and mRS scores of 3 to 6 were grouped into the "unfavourable" category. Only cases of proven ruptured aneurysmal SAH involving anterior circulation that underwent surgical clipping were included in the study. The data collected was analysed using the Statistical Package for Social Sciences (SPSS). Univariate and multivariate analyses were performed and a P-value of < 0.05 was considered to be statistically significant.Result: A total of 105 patients were included. The group was comprised of 42.9% male and 57.1% female patients. The mean GCS of the patients subjected to surgical clipping was 13, with the majority falling into the good clinical grade (78.1%). The mean timing of the surgery after SAH was 5.3 days and this was further categorised into early (day one to day three, 45.3%), intermediate (day four to day ten, 56.2%), and late (after day ten, 9.5%). The total favourable outcome achieved at discharge was 59.0% as compared to 41.0% of the unfavourable outcome, with an overall mortality rate of 10.5%. At the six-month post surgery review (n = 94), the patients with a favourable outcome constituted 71.3% as compared to 28.7% with an unfavourable outcome. The mortality, six months post surgery was 3.2%. On a univariate analysis of early surgical clipping, patients with a better GCS and good clinical grade had a significantly better outcome at MethodologyA single centre retrospective study with review of case notes was performed involving 105 patients, who were surgically treated for ruptured intracranial aneurysms from July 2011 until January 2016. Information collected included, the patient demographics, presenting symptoms, Glasgow Coma Scale (GCS) prior to surgery, timing between SAH ictus and surgery, duration of surgery, location of aneurysm, and maximum size of the aneurysm. A patient's preoperative neurological condition was classified using the World Federation of Neurosurg...

Clinical Characteristics of Poor-Grade Aneurysmal Subarachnoid Hemorrhage Treatment

“…Male gender and younger age are associated with favorable outcome after poor-grade SAH. 9 Of all patients, 66.4% were female, which in consistence with others studies. 13 Although the percentage of complications and poor outcomes is related to age, the current view is that patients in the geriatric population, including those over 80 years, should be treated surgically, if the quality of life was satisfactory before SAH.…”

“…The term "poor-grade SAH" refers to patients who were classified as score 4 or 5 according to the HH score at the time of admission to the hospital. 14 Based on the admission, Glasgow Coma Score (GCS) patients were divided into three groups: GCS (8)(9)(10)(11)(12), GCS (5)(6)(7)(8), and deepest coma GCS 3 and 4. The location of the aneurysms was divided into nine groups according to the occurrence in the projection of the Willis circle.…”

“…The incidence of re-hemorrhage is the highest within 24 hours of the hemorrhage, while mortality after re-hemorrhage is up to 75%. 2,[9][10][11][12][13] Given the high mortality of patients with poor HH score and high rate of hemorrhage, the aim of this study was to evaluate the clinical characteristics and outcome of poorgrade aneurysmal SAH at our institution.…”

“…The incidence of re-hemorrhage is the highest within 24 hours of the hemorrhage, while mortality after re-hemorrhage is up to 75%. 2 9 10 11 12 13 …”

Predictors of poor outcome from aneurysmal subarachnoid hemorrhage and an exploratory analysis into the causes of delayed neurosurgical clipping at a major public hospital in the Philippines

“…Peculiar in our study setting would be the late time interval to surgery for the majority of the patients. Although the timing of surgery is not statistically signi cant-similar to what was found in studies with clipping as the exclusive intervention 17,18,19,20,21 -this remains a modi able factor in the institutional or regional catchment setup of our center, partly because the delays are avoidable for the most part.…”