• Satoshi Shirao, Hiroshi Yoneda, Ichiro Kunitsugu, Hideyuki Ishihara, Hiroyasu Koizumi, Eiichi Suehiro, Sadahiro Nomura, Shoichi Kato, Hirosuke Fujisawa, and Michiyasu Suzuki.
• Department of Neurosurgery and Clinical Neuroscience, Yamaguchi University School of Medicine, Ube, Japan. shirao@yamaguchi-u.ac.jp
• Cerebrovasc. Dis. 2010 Jan 1;30(2):105-13.

BackgroundThe management of patients with poor-grade subarachnoid hemorrhage (SAH) continues to be controversial. The objective of this study was to examine predictors of outcome of poor-grade SAH after surgical obliteration of the aneurysm.MethodsThe study was performed as a retrospective review of 283 patients with poor-grade SAH who underwent surgical obliteration of the aneurysm at multiple centers in Chugoku and Shikoku, Japan.ResultsA favorable outcome at discharge was achieved in 97 of the 283 patients (34.3%). Age (p < 0.001), World Federation of Neurosurgical Societies (WFNS) grade V at admission (p = 0.002), improvement in WFNS grade after admission (p = 0.002), Fisher grade (p = 0.039) and a low-density area (LDA) associated with vasospasm on computed tomography (CT; p < 0.001) showed a significant association with outcome. Further analysis of WFNS grades indicated that most patients who only improved to preoperative grade IV from grade V at admission did not have a favorable outcome. Multivariate analysis identified age (especially of > or =65 years; p < 0.001), WFNS grade V (p < 0.001) and LDA associated with vasospasm on CT (p < 0.001) as predictors of a poor outcome, and improvement in WFNS grade (p = 0.001) as a predictor of a favorable outcome after surgical obliteration of the aneurysm.ConclusionsAdvanced age, WFNS grade V, improvement in WFNS grade, and LDA associated with vasospasm on CT were found to be independent predictors of clinical outcome, whereas rebleeding, early aneurysm surgery and treatment modality (surgical clipping or Guglielmi detachable coil embolization) were not independently associated with outcome in patients with poor-grade aneurysm.Copyright (c) 2010 S. Karger AG, Basel.

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