What Do We Mean by Poor-Grade Aneurysmal Subarachnoid Hemorrhage and What Can We Do?

Objective: The surgical outcomes of anterior circle of Willis aneurysms were evaluated. Material and Methods: Between March 2015 and December 2016, 38 patients were operated and followed up for aneurysms. There were 15 female and 23 male patients with a mean age of 47 years (range: 17-78). Of the patients, 35 were diagnosed with subarachnoid hemorrhage (SAH). Of these patients, 54.2% (n=19) were operated within the first 24 hours. All patients were operated by the same surgeon with sylvian dissection. All clinical data in the hospital charts and outpatient records and radiological investigations stored in the archive were evaluated retrospectively. Results:The most commonly seen aneurysm was on the anterior communicating artery (44.8%). After that, aneurysms on the middle cerebral artery (31.6%), posterior communicating artery (13.2%), internal cerebral artery bifurcation (7.8%), and distal anterior cerebral artery were seen, respectively. There was a significant correlation between the location of the aneurysm and the mean age (p=0.009). All patients were followed in the intensive care unit after operation. After surgery, vasospasm was observed in 26.3% of patients. Patients with high SAH grade developed vasospasm significantly more frequently (p=0.03). Neurological examinations at discharge were normal in 17 patients with SAH and 3 patients without SAH. Four patients were discharged with minimal neurological deficit and 2 patients with severe deficit. Eight patients with World Federation of Neurosurgical Societies (WFNS) grade 4-5, 2 patients with grade 3, and 2 patients with grade 1-2 were lost. Postoperative Glasgow Coma Scale and SAH WFNS grades were found to be determinants for dying. Conclusion: Despite the development of endovascular techniques in the treatment of aneurysm, microsurgical clipping remains the first choice method to treat anterior system aneurysms. Closure of the aneurysm is the treatment priority. It is well known that early surgery reduces mortality and morbidity. Keywords: aneurysm, clip, aneurysm surgery, microsurgical clipping, subarachnoid hemorrhage, circle of Willis ÖZET Willis poligonu anterior dolaşım anevrizmalarının mikroşirurjikal yöntemle klipslenmesi: Retrospektif çalışmaAmaç: Willis poligonu anterior sistem anevrizmalarının cerrahi sonuçlarının değerlendirilmesi. Yöntem ve Gereçler: Mart 2015-Aralık 2016 arasında intrakranyal anevrizma nedeniyle kliniğimizde ardı ardına 38 hasta ameliyat edildi. On beş kadın ve 23 erkek hastanın yaş ortalaması 47 (aralığı: 17-78) idi. Otuz beş hastada subaraknoid kanama (SAK) vardı ve bunların %54,2'si (n=19) ilk 24 saatte ameliyata alındı. Hastalar aynı cerrah tarafından silviyan diseksiyon yöntemi kullanılarak opere edildi. Çalışmamız klinik kayıt ve radyolojik görüntü arşivleri kullanılarak retrospektif olarak gerçekleştirildi. Bulgular: En fazla anterior komminikan arter anevrizması görüldü (44.8%). Sonra sırasıyla middle serebral arter (31.6 %), posterior komunikan arter (13.2 %), internal serebral arter (7.8%) ve distal anteri...

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“…(approximately half before clipping) (23,24). In our study, the mortality rate of grade 4-5 patients was also very high.…”

Section: Discussionsupporting

confidence: 54%

Microsurgical clipping of anterior circle of willis aneurysms: a retrospective study

Eren¹,

Güzey²,

Yücel³

et al. 2017

Bagcilar Medical Bulletin

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“…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 …”

Section: Methodsmentioning

confidence: 99%

“…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.…”

Section: Methodsmentioning

confidence: 99%

Clinical Characteristics of Poor-Grade Aneurysmal Subarachnoid Hemorrhage Treatment

et al. 2023

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Background The initial clinical status after aneurysm rupture, whether primary or secondary, determines the final outcome. The most common cause of patient deterioration is a high Hunt and Hess (HH) score, which correlates closely with a high mortality rate. Poor-grade aneurysmal subarachnoid hemorrhage (SAH) is determined as an HH score 4 or 5. The aim of this study was to evaluate the clinical characteristics of poor graded aneurysmal SAH at our institution. Patients and Methods During the 5-year period, 415 patients with intracranial aneurysm were admitted to our institution. Patients with poor-grade aneurysmal SAH accounted 31.08% (n = 132) of the total number of ruptured aneurysms. Interventional treatment was predominantly in the form of surgery, whereas conservative treatment included medication and external ventricular drainage. Final outcome was assessed with a modified Rankin score (mRs). Statistical analysis was performed using SPSS version 23.0 with a significance level set to 5% (α = 0.05). Results The majority of patients (57.6%) were in the age range from 51 to 69 years. Twenty-five patients (18.9%) had an HH score of 4, whereas 107 patients (81.1%) had an HH score of 5. Depending on the location, the majority of patients (n = 43) had an aneurysm on the medial cerebral artery (MCA). The final aneurysm occlusion was performed in 71 patients, of whom 94.36% were treated surgically. A positive outcome (mRs 0–4) was found in 49.25% of patients who underwent primarily surgical, treatment with a mortality of 42.3%. Although the outcome was better in patients with an HH score 4, both groups benefited from surgical treatment. Conclusion Poor-grade aneurismal SAH is a condition of the middle and older age, with most patients with an HH 5 score and deep comatose state. There was better outcome in patients with an HH score of 4 compared to an HH score of 5 and both groups benefited from surgical treatment, which resulted in a positive outcome in almost 50% of surgically treated patients.

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“…Aneurysmal SAH is a life-threatening disease with high mortality and disability rates (1)(2)(3)(4). Increasing fundamental and clinical research has suggested that early brain injury (EBI) is the most critical cause of the subsequent delayed cerebral vasospasm, delayed neurological dysfunction, and mortality and disability in patients (5)(6)(7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Feasibility of FDCT Early Brain Parenchymal Blood Volume Maps in Predicting Short-Term Prognosis in Patients With Aneurysmal Subarachnoid Hemorrhage

Wen

Zhou

et al. 2022

Front. Neurol.

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PurposeAneurysmal subarachnoid hemorrhage (SAH) is accompanied by cerebral perfusion changes. We aimed to measure the parenchymal blood volume (PBV) maps acquired by C-arm flat-panel detector CT (FDCT) to assess the cerebral blood volume at an early stage in aneurysmal SAH and to explore the correlation with the outcomes at discharge.MethodsData of 66 patients with aneurysmal SAH who underwent FDCT PBV examination were retrospectively analyzed. The PBV of regions of interest, including the cortices of the bilateral frontal lobe, the parietal lobe, the occipital lobe, and the cerebral hemisphere, as well as the basal ganglia, were measured and quantitatively analyzed. The clinical and imaging data of the patients were also collected, and logistic regression analysis was performed to explore the correlation between the perfusion parameters and outcomes at discharge.ResultsThe favorable and poor outcomes at discharge were found in 37 (56.06%) and 29 (43.94%) patients, respectively. The whole-brain PBV was significantly correlated with the Hunt-Hess grades (p < 0.005) and the WFNSS grades (p < 0.005). The whole-brain PBV of the poor prognosis was significantly higher than that of the favorable prognosis (35.17 ± 7.66 vs. 29.78 ± 5.54, p < 0.005). The logistic regression analysis showed that the PBV of the parietal lobe at the bleeding side (OR = 1.10, 95%CI: 1.00–1.20, p = 0.04) was an independent risk factor predicting the short-term prognosis.ConclusionsParenchymal blood volume (PBV) maps could reflect the cerebral blood volume throughout the brain to characterize its perfusion status at an early stage in aneurysmal SAH. It enables a one-stop imaging evaluation and treatment in the same angio-suite and may serve as a reliable technique in clinical assessment of aneurysmal SAH.

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What Do We Mean by Poor-Grade Aneurysmal Subarachnoid Hemorrhage and What Can We Do?

Cited by 4 publications

References 24 publications

Microsurgical clipping of anterior circle of willis aneurysms: a retrospective study

Microsurgical clipping of anterior circle of willis aneurysms: a retrospective study

Clinical Characteristics of Poor-Grade Aneurysmal Subarachnoid Hemorrhage Treatment

Feasibility of FDCT Early Brain Parenchymal Blood Volume Maps in Predicting Short-Term Prognosis in Patients With Aneurysmal Subarachnoid Hemorrhage

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