title: The outcomes of early aneurysm repair in World Federation of Neurosurgical Societies grade V subarachnoid haemorrhage patients with emphasis on those presenting with a Glasgow Coma Scale score of 3.
abstract: Grade V subarachnoid haemorrhage (SAH) patients may be dichotomised into those with temporary deterioration and those with irreversible injury, and only the former have a chance of favourable outcomes by aneurysm obliteration. One method of differentiating the two conditions is to wait and observe potential recovery for 12-48hours. However, early rebleeding and non-convulsive seizures may occur during this period. In our institution, grade V SAH patients receive immediate treatment (general anaesthesia induction and aneurysm obliteration within 24hours of onset) to minimise those risks. We focused on therapeutic outcomes in SAH patients presenting with a Glasgow Coma Scale score of 3 (GCS-3). Between January 2006 and December 2013, 82 GCS-3 SAH patients were admitted, among whom 51 (62%) underwent immediate aneurysm obliteration. Their outcomes 90days after onset were evaluated with the Glasgow Outcome Scale, with either good recovery or moderate disability regarded as favourable outcomes. Multivariate logistic regression analysis was performed to identify variables correlated with favourable outcomes. Among the 51 patients, 11 (22%) had favourable 90-day outcomes. Age (odds ratio [OR], 0.838; 95% confidence interval [CI], 0.733-0.959; p=0.010) and intact pupillary light reflex (OR, 21.939; 95% CI, 1.465-328.576; p=0.025) were correlated with favourable outcomes. By contrast, neither intact respiratory pattern nor isocoric pupils was correlated with favourable outcomes. The current results indicate that vigorous intervention may be worth attempting in young GCS-3 SAH patients with intact pupillary light reflex. It remains unclear, however, whether the seemingly high frequency of favourable outcomes was truly due to reduction in early rebleeding or seizures.
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, 1-98 Dengakugakubo, Toyoake 470-1192, Japan. Electronic address: inamasu@fujita-hu.ac.jp.
authors.forename: Joji
authors.initials: J
authors.lastname: Inamasu
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, 1-98 Dengakugakubo, Toyoake 470-1192, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Nakae
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, 1-98 Dengakugakubo, Toyoake 470-1192, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Ohmi
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, 1-98 Dengakugakubo, Toyoake 470-1192, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Kogame
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, 1-98 Dengakugakubo, Toyoake 470-1192, Japan.
authors.forename: Yushi
authors.initials: Y
authors.lastname: Kawazoe
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, 1-98 Dengakugakubo, Toyoake 470-1192, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kumai
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, 1-98 Dengakugakubo, Toyoake 470-1192, Japan.
authors.forename: Riki
authors.initials: R
authors.lastname: Tanaka
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, 1-98 Dengakugakubo, Toyoake 470-1192, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Wakako
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, 1-98 Dengakugakubo, Toyoake 470-1192, Japan.
authors.forename: Kiyonori
authors.initials: K
authors.lastname: Kuwahara
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, 1-98 Dengakugakubo, Toyoake 470-1192, Japan.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Ganaha
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, 1-98 Dengakugakubo, Toyoake 470-1192, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Hirose
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D015600:Glasgow Coma Scale / Q000592:standards*; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012955:Societies, Medical / Q000592:standards*; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome
keywords: General anaesthesia; Glasgow Coma Scale; Grade V; Outcome; Subarachnoid haemorrhage