• World Neurosurg · May 2019

    Pre-operative predictors and prognosticators after microsurgical clipping of poor grade subarachnoid hemorrhage: A retrospective study.

    • Nakao Ota, Kosumo Noda, Yuto Hatano, Atsumu Hashimoto, Takanori Miyazaki, Tomomasa Kondo, Yu Kinoshita, Hiroyasu Kamiyama, Sadahisa Tokuda, Kyousuke Kamada, and Rokuya Tanikawa.
    • Stroke Center, Department of Neurosurgery, Sapporo Teishinkai Hospital Higashi-ku, Sapporo, Hokkaido, Japan.
    • World Neurosurg. 2019 May 1; 125: e582-e592.

    BackgroundContrary to expectations, some patients with poor-grade subarachnoid hemorrhage (SAH) show favorable outcomes. However, the factors predictive of good prognosis are unclear. The purposes of this study were to identify factors related to poor-grade SAH and to analyze preoperative prognostic factors.MethodsWe included 186 patients with SAH who underwent surgical clipping or conservative treatment immediately after SAH diagnosis. Physiologic, radiographic, and blood examination data were collected retrospectively. Factors related to poor World Federation of Neurological Societies (WFNS) grade (WFNS IV and V) and poor outcome (modified Rankin Scale scores 3-6) were analyzed.ResultsThe patients (mean age, 61.6 years) included 134 women (72%). Seventy patients (38.2%) had poor WFNS scores. On multivariate analysis, age ≥70 years (adjusted odds ratio [OR], 3.73), midline shift (OR, 4.89), and the absence of cerebrospinal fluid in the high-convexity cortical sulci (OR, 5.47) and ambient cistern (OR, 4.83) were predictive of poor WFNS scores. Age ≥70 years (OR, 8.36), WFNS grade 5 (OR, 15.35), intracerebral hematoma (OR, 3.32), and Evans index (EI) ≥0.3 (OR, 4.40) were predictive of poor outcome. Body mass index (OR, 0.87), intraventricular hemorrhage (OR, 3.86), glycated hemoglobin level (OR, 2.78), and age ≥70 years (OR, 4.12) were predictive of EI ≥0.3.ConclusionsPoor outcomes correlated with older age, brain-destructive hemorrhage, and EI ≥0.3. The EI reflects both hydrocephalus and the patient's frailty. Radiographic signs of poor-grade SAH were not correlated with poor outcome, suggesting that early decompressive surgery may improve outcome.Copyright © 2019 Elsevier Inc. All rights reserved.

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