Poor-Grade Aneurysmal Subarachnoid Hemorrhage: Factors Influencing Functional Outcome--A Single-Center Series.
OBJECTIVE
Patients presenting with poor-grade aneurysmal subarachnoid hemorrhage (SAH) have commonly been reported to have a poor prognosis; however, several reports suggest a favorable outcome in a subgroup of patients. We analyzed our database to identify factors determining functional outcome after poor-grade SAH.


METHODS
During the period 2004-2014, 248 patients with poor-grade SAH were treated in our institution. Poor-grade SAH was defined as World Federation of Neurological Surgeons grades IV-V on admission. Data including patient characteristics, treatment modality, radiologic features, and functional neurologic outcome were assessed and further analyzed. Outcome was assessed according to the modified Rankin Scale after 6 months and stratified into favorable (modified Rankin Scale score 0-2) versus unfavorable (modified Rankin Scale score 3-6). A multivariate analysis was performed to identify predictors of functional outcome.


RESULTS
A favorable outcome was achieved in 24% of patients with poor-grade SAH. Patients with a favorable outcome were significantly younger (P = 0.005), harbored significantly smaller aneurysms (P = 0.004), and had a lower initial World Federation of Neurological Surgeons grade (P < 0.0001). An unfavorable outcome was significantly more frequent in patients with additional space-occupying hematoma compared with patients without additional space-occupying hematoma (P = 0.0009). On multivariate analysis, patient age, World Federation of Neurological Surgeons grade V, signs of cerebral herniation, aneurysm size, and presence of space-occupying hematoma were identified as significant predictors of unfavorable outcome in patients with poor-grade SAH.


CONCLUSIONS
A favorable outcome was achieved in 24% of severely ill patients with poor-grade SAH. Therefore, treatment of patients with poor-grade SAH should not be omitted. Careful individualized decision making is necessary for each patient.
Department of Neurosurgery, University of Bonn, Bonn, Germany. Electronic address: patrick.schuss@ukb.uni-bonn.de.
Patrick
P
Schuss
Department of Neurosurgery, University of Bonn, Bonn, Germany.
Alexis
A
Hadjiathanasiou
Department of Neurosurgery, University of Bonn, Bonn, Germany.
Valeri
V
Borger
Department of Neurosurgery, University of Bonn, Bonn, Germany.
Christian
C
Wispel
Department of Neurosurgery, University of Bonn, Bonn, Germany.
Hartmut
H
Vatter
Department of Neurosurgery, University of Bonn, Bonn, Germany.
Erdem
E
Güresir
D000328:Adult; D000367:Age Factors; D000368:Aged; D003131:Combined Modality Therapy; D056424:Decompressive Craniectomy; D004621:Embolization, Therapeutic; D005260:Female; D006408:Hematoma, Subdural / Q000145:classification / Q000601:surgery; D006801:Humans; D002532:Intracranial Aneurysm / Q000145:classification / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000209:etiology*; D011379:Prognosis; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000145:classification / Q000601:surgery*; D013525:Surgical Instruments; D016896:Treatment Outcome
Intracranial aneurysm; Poor-grade SAH; Subarachnoid hemorrhage