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Indian Journal of Neurosurgery 2015; 04(02): 063-068
DOI: 10.1055/s-0035-1558966
Original Article
Neurological Surgeons' Society of India

Clinical Demographic Association and Outcome in Patients with Aneurysmal Subarachnoid Hemorrhage

Mayank Bansal
1   Department of Neurosurgery, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
,
R. S. Mittal
1   Department of Neurosurgery, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
› Author Affiliations
Further Information

Publication History

08 April 2015

25 May 2015

Publication Date:
29 July 2015 (online)

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Abstract

Introduction Even in this modern era of neurosurgery, we could not achieve 0% mortality in operated aneurysmal subarachnoid hemorrhage (SAH) patients. An analysis of factors affecting outcome was never published in detail, and a recent update of guidelines for management of aneurysm SAH noted deficiency in knowledge about this issue.

Objective The study aims to assess the effect of various factors on the outcome of operated aneurysmal SAH patients.

Methods: The various factors regarding age, sex, associated chronic diseases, clinical condition of patients, surgery interval, and nature of aneurysm were correlated with outcomes of 345 operated aneurismal SAH patients. Statistical analysis was done by chi-square test and logistic regression.

Results As per grade, patients' survival is 80.16% for fair grade and 21.65 % for poor grade, which was statistically significant (p < 0.001). No significant difference was observed for other factors analyzed independently (p > 0.05). On comparing with Hunt and Hess (H-H) grade, all the above-mentioned variables showed significantly better survival in fair grade than in poor grade (p < 0.05). The Wald criteria demonstrated that only H-H grade made a significant contribution to prediction.

Conclusion Although a number of factors seem to affect the outcome of aneurismal SAH patients, it is the grade at presentation, which comes out to be an independent variable, influencing the outcome of patients. Patients presented with fair grade tend to have better outcome than those presented with poor grade. All other factors do not have significant impact over the outcome of clipped aneurysm patients with SAH.

Keywords

aneurysm - subarachnoid hemorrhage - clipping - Hunt and Hess grade
 

  • References

  • 1 Broderick JP, Phillips SJ, Whisnant JP, O'Fallon WM, Bergstralh EJ. Incidence rates of stroke in the eighties: the end of the decline in stroke?. Stroke 1989; 20 (5) 577-582
    CrossrefPubMedGoogle Scholar
  • 2 Phillips II LH, Whisnant JP, O'Fallon WM, Sundt Jr TM. The unchanging pattern of subarachnoid hemorrhage in a community. Neurology 1980; 30 (10) 1034-1040
    CrossrefPubMedGoogle Scholar
  • 3 Ingall TJ, Whisnant JP, Wiebers DO, O'Fallon WM. Has there been a decline in subarachnoid hemorrhage mortality?. Stroke 1989; 20 (6) 718-724
    CrossrefPubMedGoogle Scholar
  • 4 Feigin VL, Rinkel GJ, Lawes CM , et al. Risk factors for subarachnoid hemorrhage: an updated systematic review of epidemiological studies. Stroke 2005; 36 (12) 2773-2780
    CrossrefPubMedGoogle Scholar
  • 5 Bhat AR, Afzalwani M, Kirmani AR. Subarachnoid hemorrhage in Kashmir: Causes, risk factors, and outcome. Asian J Neurosurg 2011; 6 (2) 57-71
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Nieuwkamp DJ, Setz LE, Algra A, Linn FH, de Rooij NK, Rinkel GJ. Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: a meta-analysis. Lancet Neurol 2009; 8 (7) 635-642
    CrossrefPubMedGoogle Scholar
  • 7 Sodhi HBS, Savardekar AR, Mohindra S, Chhabra R, Gupta V, Gupta SK. The clinical profile, management, and overall outcome of aneurysmal subarachnoid hemorrhage at the neurosurgical unit of a tertiary care center in India. J Neurosci Rural Pract 2014; 5 (2) 118-126
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Kassell NF, Torner JC, Haley Jr EC, Jane JA, Adams HP, Kongable GL. The international cooperative study on the timing of aneurysm surgery. Part 1: overall management results. J Neurosurg 1990; 73 (1) 18-36
    CrossrefPubMedGoogle Scholar
  • 9 Torner JC, Kassell NF, Wallace RB, Adams Jr HPJ. Preoperative prognostic factors for rebleeding and survival in aneurysm patients receiving antifibrinolytic therapy: report of the Cooperative Aneurysm Study. Neurosurgery 1981; 9 (5) 506-513
    CrossrefPubMedGoogle Scholar
  • 10 Niskanen MM, Hernesniemi JA, Vapalahti MP, Kari A. One-year outcome in early aneurysm surgery: prediction of outcome. Acta Neurochir (Wien) 1993; 123 (1-2) 25-32
    CrossrefPubMedGoogle Scholar
  • 11 Shingare A, Nadkar MY, Singh R. Study of patient characteristics/profile and factors determining the (immediate) outcome in spontaneous subarachnoid hemorrhage. J Assoc Physicians India 2011; 59: 505-508
    PubMedGoogle Scholar
  • 12 Siddiq F, Chaudhry SA, Tummala RP, Suri MF, Qureshi AI. Factors and outcomes associated with early and delayed aneurysm treatment in subarachnoid hemorrhage patients in the United States. Neurosurgery 2012; 71 (3) 670-677 , discussion 677–678
    CrossrefPubMedGoogle Scholar
  • 13 Roganović Z, Pavlićević G. Factors influencing the outcome after the operative treatment of cerebral aneurysms of anterior circulation. Vojnosanit Pregl 2002; 59 (5) 463-471
    CrossrefPubMedGoogle Scholar
  • 14 Whitfield PC, Kirkpatrick PJ. Timing of surgery for aneurysmal subarachnoid haemorrhage. Cochrane Database Syst Rev 2001; (2) CD001697
    PubMedGoogle Scholar
  • 15 Rosengart AJ, Schultheiss KE, Tolentino J, Macdonald RL. Prognostic factors for outcome in patients with aneurysmal subarachnoid hemorrhage. Stroke 2007; 38 (8) 2315-2321
    CrossrefPubMedGoogle Scholar
  • 16 Goto Y, Yamagata S. Deteriorating factors on the outcome in patients with fair grade of subarachnoid hemorrhage (WFNS grade I and II) [in Japanese]. No Shinkei Geka 2006; 34 (6) 577-582
    PubMedGoogle Scholar
  • 17 Hutchinson PJ, Power DM, Tripathi P, Kirkpatrick PJ. Outcome from poor grade aneurysmal subarachnoid haemorrhage—which poor grade subarachnoid haemorrhage patients benefit from aneurysm clipping?. Br J Neurosurg 2000; 14 (2) 105-109
    CrossrefPubMedGoogle Scholar
  • 18 Bonilha L, Marques EL, Carelli EF , et al. Risk factors and outcome in 100 patients with aneurysmal subarachnoid hemorrhage. Arq Neuropsiquiatr 2001; 59 (3B): 676-680
    CrossrefPubMedGoogle Scholar
  • 19 Kaminogo M, Yonekura M, Shibata S. Incidence and outcome of multiple intracranial aneurysms in a defined population. Stroke 2003; 34 (1) 16-21
    CrossrefPubMedGoogle Scholar
  • 20 Bazowski P, Gamrot J, Rudnik A, Konopka M. Analysis of selected prognostic factors in patients with ruptured cerebral aneurysms operated-on in the early period [in Polish]. Neurol Neurochir Pol 1992; (Suppl. 01) 25-28
    PubMedGoogle Scholar
  • 21 Gomis P, Rousseaux P, Jolly D, Graftieaux JP. Initial prognostic factors of aneurysmal subarachnoid hemorrhage [in French]. Neurochirurgie 1994; 40 (1) 18-30
    PubMedGoogle Scholar
  • 22 Shirao S, Yoneda H, Kunitsugu I , et al. Preoperative prediction of outcome in 283 poor-grade patients with subarachnoid hemorrhage: a project of the Chugoku-Shikoku Division of the Japan Neurosurgical Society. Cerebrovasc Dis 2010; 30 (2) 105-113
    CrossrefPubMedGoogle Scholar
  • 23 Duong DH, Kolluri VR, Spittaler PJ, Sengupta RP. Risk Score Estimation: a new method to determine optimal timing of aneurysm clipping for improved management outcome. Neurol Res 1998; 20 (3) 218-224
    PubMedGoogle Scholar
  • 24 Lanzino G, Kassell NF, Germanson TP , et al. Age and outcome after aneurysmal subarachnoid hemorrhage: why do older patients fare worse?. J Neurosurg 1996; 85 (3) 410-418
    CrossrefPubMedGoogle Scholar
  • 25 Ohman J, Heiskanen O. Timing of operation for ruptured supratentorial aneurysms: a prospective randomized study. J Neurosurg 1989; 70 (1) 55-60
    CrossrefPubMedGoogle Scholar
  • 26 Sardana V, Maheshwari D, Aseri RK. Subarachnoid hemorrhage: current overview. Int J Basic Applied Med Sci 2012; 2 (3) 257-271
    PubMedGoogle Scholar
  • 27 Kleinpeter G, Lehr S. Is hypertension a major risk factor in aneurysmal subarachnoid hemorrhage?. Wien Klin Wochenschr 2002; 114 (8-9) 307-314
    PubMedGoogle Scholar
  • 28 de Gans K, Nieuwkamp DJ, Rinkel GJ, Algra A. Timing of aneurysm surgery in subarachnoid hemorrhage: a systematic review of the literature. Neurosurgery 2002; 50 (2) 336-340 , discussion 340–342
    CrossrefPubMedGoogle Scholar
  • 29 Zhang Q, Ma L, Liu Y , et al. Timing of operation for poor-grade aneurysmal subarachnoid hemorrhage: study protocol for a randomized controlled trial. BMC Neurol 2013; 13: 108
    CrossrefPubMedGoogle Scholar
  • 30 Laidlaw JD, Siu KH. Poor-grade aneurysmal subarachnoid hemorrhage: outcome after treatment with urgent surgery. Neurosurgery 2003; 53 (6) 1275-1280 , discussion 1280–1282
    CrossrefPubMedGoogle Scholar
  • 31 Zubkov YN. Treatment of patients with intracranial arterial aneurysms in the haemorrhagic period. Neurol Res 1994; 16 (1) 6-8
    PubMedGoogle Scholar
  • 32 Ross N, Hutchinson PJ, Seeley H, Kirkpatrick PJ. Timing of surgery for supratentorial aneurysmal subarachnoid haemorrhage: report of a prospective study. J Neurol Neurosurg Psychiatry 2002; 72 (4) 480-484
    PubMedGoogle Scholar
  • 33 Vajda J. Multiple intracranial aneurysms: a high risk condition. Acta Neurochir (Wien) 1992; 118 (1-2) 59-75
    CrossrefPubMedGoogle Scholar
  • 34 Rinne J, Hernesniemi J, Niskanen M, Vapalahti M. Management outcome for multiple intracranial aneurysms. Neurosurgery 1995; 36 (1) 31-37 , discussion 37–38
    CrossrefPubMedGoogle Scholar
  • 35 Mizoi K, Suzuki J, Yoshimoto T. Surgical treatment of multiple aneurysms. Review of experience with 372 cases. Acta Neurochir (Wien) 1989; 96 (1-2) 8-14
    CrossrefPubMedGoogle Scholar
  • 36 Inagawa T. Surgical treatment of multiple intracranial aneurysms. Acta Neurochir (Wien) 1991; 108 (1-2) 22-29
    CrossrefPubMedGoogle Scholar
  • 37 Orz Y, Osawa M, Tanaka Y, Kyoshima K, Kobayashi S. Surgical outcome for multiple intracranial aneurysms. Acta Neurochir (Wien) 1996; 138 (4) 411-417
    CrossrefPubMedGoogle Scholar
  • 38 Gaivas S, Rotariu D, Iliescu B, Ziyad F, Apetrei C, Poeată I. Multiple intracranial aneurysms: incidence and outcome in a series of 357 patients. Rom. Neurosurg. XVIII 2011; 4: 450-455
    PubMedGoogle Scholar