Long-term Neurological Outcome and Quality of Life after World Federation of Neurosurgical Societies Grades IV and V Aneurysmal Subarachnoid Hemorrhage in an Interdisciplinary Treatment Concept.
BACKGROUND
Detailed data on long-term functional outcome of patients with World Federation of Neurosurgical Societies (WFNS) grades IV and V aneurysmal subarachnoid hemorrhages (aSAH) are still scarce.


OBJECTIVE
Assessment of long-term outcome of WFNS IV and V aSAH patients.


METHODS
Functional outcome and quality of life were assessed by the modified Rankin scale (mRS) and the 36-item short-form health survey in consecutively treated aSAH WFNS IV and V patients between 2005 and 2010. Scores from the 36-item short-form health survey were compared to a healthy German population. Prognostic factors were analyzed by uni- and multivariate models.


RESULTS
One hundred and seven eligible patients (median age: 53.0 years) were identified. After interdisciplinary consensus on optimal treatment, aneurysms were obliterated either by clipping (n = 35) or by coiling (n = 72). Ten patients were lost to long-term follow-up; the median clinical follow-up period was 3.2 years for the remaining 97 cases. Twenty-five of 97 died during the acute hospital phase and another 10 patients over the follow-up period leaving 62 long-term survivors. At the end of clinical follow-up, 40/97 patients, including 40/62 of long-term survivors, reached functional independence (mRS ≤ 2). Twelve of 97 patients were moderately (mRS = 3), 10/97 patients were severely disabled (mRS ≥ 4). Younger age (≤ 53 years; P = .001) and radiological absence of cerebral infarction ( P = .03) were the strongest predictors for favorable outcome. Quality of life was perceived to be only moderately reduced compared to the healthy control group.


CONCLUSIONS
Poor-grade aSAH is not necessarily associated with poor long-term functional outcome; after aneurysm repair ∼60% of patients survived and among long-term survivors ∼ 60% regained functional independence.
Department?of?Neurosurgery, Ludwig- Maximilians-University, Munich, Germ-any.
Christoph
C
Schwartz
Department of Ne-urology, Ludwig-Maximilians-University, Munich, Germany.
Thomas
T
Pfefferkorn
Department of Ne-urology, Ludwig-Maximilians-University, Munich, Germany.
Caroline
C
Ebrahimi
Department of Ne-urology, Ludwig-Maximilians-University, Munich, Germany.
Caroline
C
Ottomeyer
Institute of Neuroradiology, Ludwig-Maximilians-University, Munich, Germany.
Gunther
G
Fesl
Department of Ne-urology, Ludwig-Maximilians-University, Munich, Germany.
Andreas
A
Bender
Department of Ne-urology, Ludwig-Maximilians-University, Munich, Germany.
Andreas
A
Straube
Department of Ne-urology, Ludwig-Maximilians-University, Munich, Germany.
Hans-Walter
HW
Pfister
Department of Ne-urology, Ludwig-Maximilians-University, Munich, Germany.
Suzette
S
Heck
Department?of?Neurosurgery, Ludwig- Maximilians-University, Munich, Germ-any.
Jörg-Christian
JC
Tonn
Department?of?Neurosurgery, Ludwig- Maximilians-University, Munich, Germ-any.
Christian
C
Schichor
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D011788:Quality of Life; D020127:Recovery of Function; D013345:Subarachnoid Hemorrhage / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
Aneurysmal subarachnoid hemorrhage; Interdisciplinary treatment concept; Long-term neurological outcome; Quality of life; SF-36; WFNS grades IV and V