title: Causes of poor outcome in patients admitted with good-grade subarachnoid haemorrhage.
abstract: Surgical risk in patients with unruptured aneurysms is well known. The relative impact of surgery and natural history of subarachnoid haemorrhage (SAH) on patients in good clinical condition (World Federation of Neurological Surgeons [WFNS] grades 1 and 2) is less well quantified. The aim of this study was to determine causes of poor outcome in patients admitted in good grade SAH.
  
  
  
  A retrospective study of prospectively collected data among WFNS-1 and -2 patients: demographics, SAH and aneurysm-related data, surgical complications and outcome as assesed by the Glasgow Outcome Scale (GOS). Causes of poor outcome (GOS 1-3) were determined.
  
  
  
  During a 7-year period (2009-15), 56 patients with SAH WFNS-1 (39 patients) or WFNS-2 (17 patients) were treated surgically (21 men, 35 women; mean age, 52.4 years). According to the Fisher scale, 19 patients were grade 1 or 2; 37 patients were grade 3 or 4. Most aneurysms were located at anterior communicating (26) or middle cerebral (15) artery. Altogether, 11 patients (19.6%) achieved GOS 1-3. This was attributed to SAH-related complications in six patients (rebleeding, vasospasm), surgery in four patients (postoperative ischaemia in two, haematoma and ventriculitis in one patient each), grand-mal seizure with aspiration in one patient. Age over 60 years (p = 0.017) and presence of hydrocephalus (p < 0.001) were statistically significant predictors of poor GOS; other variables (e.g. sex, Fisher grade, aneurysm size or location, use of temporary clips, intraoperative rupture, vasospasm) were not significant.
  
  
  
  Patients admitted in good-grade SAH achieve favourable outcome following surgical aneurysm repair in the majority of cases. Negative factors include age over 60 years and presence of hydrocephalus. Aneurysm surgery following good-grade SAH still carries a small but significant risk similar to that shown in large multi-institutional trials.
authors.affiliation: Department of Neurosurgery, Regional Hospital Liberec, Husova 10, Liberec, 46001, Czech Republic. vladimir.benes@nemlib.cz.
authors.forename: Vladimír
authors.initials: V
authors.lastname: Beneš
authors.affiliation: Department of Neurosurgery, Regional Hospital Liberec, Husova 10, Liberec, 46001, Czech Republic.
authors.forename: Lubomír
authors.initials: L
authors.lastname: Jurák
authors.affiliation: Department of Neurosurgery, Regional Hospital Liberec, Husova 10, Liberec, 46001, Czech Republic.
authors.forename: Radim
authors.initials: R
authors.lastname: Brabec
authors.affiliation: Department of Neurosurgery, Regional Hospital Liberec, Husova 10, Liberec, 46001, Czech Republic.
authors.forename: Nina
authors.initials: N
authors.lastname: Nechanická
authors.affiliation: Department of Radiology, Regional Hospital Liberec, Husova 10, Liberec, 46001, Czech Republic.
authors.forename: Miroslav
authors.initials: M
authors.lastname: Šercl
authors.affiliation: Department of Radiology, Regional Hospital Liberec, Husova 10, Liberec, 46001, Czech Republic.
authors.forename: Ladislav
authors.initials: L
authors.lastname: Endrych
authors.affiliation: Department of Neurosurgery, Regional Hospital Liberec, Husova 10, Liberec, 46001, Czech Republic.
authors.forename: Pavel
authors.initials: P
authors.lastname: Buchvald
authors.affiliation: Department of Neurosurgery, Regional Hospital Liberec, Husova 10, Liberec, 46001, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Suchomel
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000601:surgery*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D013345:Subarachnoid Hemorrhage / Q000601:surgery*; D013525:Surgical Instruments / Q000009:adverse effects
keywords: Aneurysm; Outcome; Subarachnoid haemorrhage; Surgical complication