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Hidayat T, Hidayat AK. Letter to the editor: Relationship between stress hyperglycemia ratio and prognosis in patients with aneurysmal subarachnoid hemorrhage: a two-center retrospective study. Neurosurg Rev 2024; 47:444. [PMID: 39162845 DOI: 10.1007/s10143-024-02725-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 08/05/2024] [Accepted: 08/18/2024] [Indexed: 08/21/2024]
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Aineskog H, Baldvinsdóttir B, Ronne Engström E, Eneling J, Enblad P, Svensson M, Alpkvist P, Fridriksson S, Klurfan P, Hillman J, Kronvall E, Nilsson OG, Lindvall P. A National Cohort with Aneurysmal Subarachnoid Hemorrhage-Patient Characteristics, Choice of Treatment, Clinical Outcome, and Factors of Prognostic Importance. World Neurosurg 2024:S1878-8750(24)01305-6. [PMID: 39084286 DOI: 10.1016/j.wneu.2024.07.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/02/2024]
Abstract
OBJECTIVE To study associations of clinical characteristics and treatment choice with functional outcome, mortality, and time to death in a national sample of aneurysmal subarachnoidal hemorrhage patients. METHODS Data were extracted from a prospective nationwide multicenter study performed in September 2014 to March 2018. Glasgow Outcome Scale Extended (GOSE) grade, 1-year mortality, and survival probability were assessed at one year after ictus. Logistic univariate, multivariate, and Cox regression analyses were used to study the variables' associations with the outcomes. RESULTS Unfavorable dichotomized GOSE (dGOSE; grades 1-4) was observed in 35.4% of patients. Microsurgery was preferred for middle cerebral artery aneurysms and Fisher grade 4. Treatment modality was not associated with any outcome measure. Dichotomized World Federation of Neurosurgical Societies (dWFNS), age, and delayed ischemic neurological deficit (DIND) showed significant correlations with dGOSE and 1-year mortality in multivariate regression analyses. Pupil dilatation was associated with a 1-year mortality outcome. Cox regression analysis showed lower survival probability for pupil dilatation (hazard ratio [HR]: 3.546), poor dWFNS (HR: 3.688), higher age (HR: 1.051), and DIND occurrence (HR: 2.214). CONCLUSIONS The patient selection in Sweden after aneurysmal subarachnoidal hemorrhage showed similar values for dGOSE, 1-year mortality, and survival probability between patients treated with microsurgery or endovascular technique. Poor dWFNS, higher age, and DIND were significantly associated with unfavorable dGOSE, mortality, and survival probability. Pupil dilatation was significantly associated with mortality and survival probability.
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Affiliation(s)
- Helena Aineskog
- Department of Clinical Sciences - Neurosciences, Umeå University, Umeå, Sweden.
| | | | | | - Johanna Eneling
- Department of Clinical Sciences, Linköping University, Linköping, Sweden
| | - Per Enblad
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Mikael Svensson
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Peter Alpkvist
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Steen Fridriksson
- Department of Clinical Neuroscience, University of Gothenburg, Gothenburg, Sweden
| | - Paula Klurfan
- Department of Clinical Neuroscience, University of Gothenburg, Gothenburg, Sweden
| | - Jan Hillman
- Department of Clinical Sciences, Linköping University, Linköping, Sweden
| | - Erik Kronvall
- Department of Clinical Sciences - Neurosurgery, Lund University, Lund, Sweden
| | - Ola G Nilsson
- Department of Clinical Sciences - Neurosurgery, Lund University, Lund, Sweden
| | - Peter Lindvall
- Department of Clinical Sciences - Neurosciences, Umeå University, Umeå, Sweden
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Rienas W, Li R, Lee SE, Rienas C. Current Smoking Status Is Not a Risk Factor for Perioperative Outcomes in Patients with Aneurysmal Subarachnoid Hemorrhage Who Underwent Craniotomy Repair. World Neurosurg 2024; 182:e635-e643. [PMID: 38065355 DOI: 10.1016/j.wneu.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/01/2023] [Accepted: 12/02/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage is a rupture leading to blood accumulating in the subarachnoid region. Smoking status is often a risk factor for postoperative complications for vascular procedures. This study aims to retrospectively examine the effect of being a current tobacco smoker on postoperative outcomes in patients with nontraumatic subarachnoid hemorrhage. METHODS Patients with aneurysmal subarachnoid hemorrhage who underwent craniotomy were identified in the American College of Surgeons-National Surgical Quality Improvement Program database. The 30-day perioperative outcomes of current smokers were compared with those of control individuals, who were patients who had not smoked tobacco in the past year. Postoperative outcomes included death, cardiac complications, stroke, operation time >4 hours, bleeding, and other events. In addition, this study examined the same surgical outcomes in patients older than 65 years. RESULTS We found no significant difference between these 2 groups across all adverse outcomes analyzed. In patients aged >65 years, we again found no significant differences between these 2 groups across all adverse outcomes analyzed. CONCLUSIONS This study shows that although current tobacco smoker status is commonly a risk factor for vascular diseases and postoperative complications, it is not a risk factor for the postoperative variables that we analyzed during craniotomy for aneurysmal subarachnoid hemorrhage. Additional research should be conducted to determine if different procedures to treat aneurysmal subarachnoid hemorrhage may have different outcomes among smokers.
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Affiliation(s)
- William Rienas
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
| | - Renxi Li
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Seung Eun Lee
- The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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Plute T, Agarwal P, Patel A, Mallela AN, Lunsford LD, Abou-Al-Shaar H. Idiopathic De Novo Arteriovenous Malformation: A Rare Acquired Intracranial Lesion. Asian J Neurosurg 2023; 18:400-403. [PMID: 37397049 PMCID: PMC10313434 DOI: 10.1055/s-0043-1769893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023] Open
Abstract
The de novo development of cerebral arteriovenous malformations (AVMs) in adults is an exceedingly rare event that has prompted the theory that a "second hit" is required to induce AVM formation. The authors document development of an occipital AVM in an adult a decade and a half after a brain magnetic resonance imaging (MRI) disclosed no abnormality. A 31-year-old male with a family history of AVMs and a 14-year history of migraines with visual auras and seizures presented to our service. Because of the onset of a first seizure and migraine headaches at age 17, the patient underwent high-resolution MRI that showed no intracranial lesion. After 14 years of progressively worsening symptoms, he underwent a repeat MRI that demonstrated a new de novo Spetzler-Martin grade 3 left occipital AVM. The patient received anticonvulsants and underwent Gamma Knife radiosurgery for his AVM. This case suggests that patients with seizures or persistent migraine headaches should have periodic repeat neuroimaging to exclude the development of a vascular cause despite an initial negative MRI.
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Affiliation(s)
- Tritan Plute
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Prateek Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Aneek Patel
- Department of Neurological Surgery, New York University Langone Health, New York, New York, United States
| | - Arka N. Mallela
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
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Grossen A, Bauer A. In Reply to the Letter to the Editor Regarding: "Impact of Obesity and Diabetes on Postoperative Outcomes Following Surgical Treatment of Nontraumatic Subarachnoid Hemorrhage: Analysis of the ACS-NSQIP Database". World Neurosurg 2023; 170:259. [PMID: 36782417 DOI: 10.1016/j.wneu.2022.12.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 02/10/2023]
Affiliation(s)
- Audrey Grossen
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
| | - Andrew Bauer
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Ronne Engström E, Baldvinsdóttir B, Aineskog H, Alpkvist P, Enblad P, Eneling J, Fridriksson S, Hillman J, Klurfan P, Kronvall E, Lindvall P, Von Vogelsang AC, Nilsson OG, Svensson M. The impact of previous health on the mortality after aneurysmal subarachnoid hemorrhage: analysis of a prospective Swedish multicenter study. Acta Neurochir (Wien) 2023; 165:443-449. [PMID: 36633685 PMCID: PMC9922219 DOI: 10.1007/s00701-022-05464-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/14/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE There is an an increasing awareness of the importance of health and lifestyle for stroke diseases like spontaneous subarachnoid hemorrhage (SAH). However, the importance of pre-existing medical conditions for clinical course and mortality after SAH has not been studied. The aim of the present study was to identify pre-existing conditions contributing to mortality after SAH. METHODS Data were extracted from a Swedish national prospective study on patients with SAH. Variables were defined for age, sex, body mass index (BMI), clinical condition at admission, and for 10 pre-existing medical conditions. Models predicting mortality in three time intervals with all possible subsets of these variables were generated, compared and selected using Akaike's information criterion. RESULTS 1155 patients with ruptured aneurysms were included. The mortality within 1 week was 7.6%, 1 month 14.3%, and 1 year 18.7%. The most common pre-existing medical conditions were smoking (57.6%) and hypertension (38.7%). The model's best predicting mortality within 1 week and from 1 week to 1 month included only the level of consciousness at admission and age, and these two variables were present in all the models among the top 200 in Akaike score for each time period. The most predictive model for mortality between 1 month and 1 year added previous stroke, diabetes, psychiatric disease, and BMI as predictors. CONCLUSION Mortality within the first month was best predicted simply by initial level of consciousness and age, while mortality within from 1 month to 1 year was significantly influenced by pre-existing medical conditions.
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Affiliation(s)
| | | | - Helena Aineskog
- Neurosurgery, Clinical Sciences, Umea University, Umeå, Sweden
| | - Peter Alpkvist
- Neurosurgery, Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Per Enblad
- Neurosurgery, Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Johanna Eneling
- Neurosurgery, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Steen Fridriksson
- Neurosurgery, Clinical Neuroscience, Gothenburg University, Gothenburg, Sweden
| | - Jan Hillman
- Neurosurgery, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Paula Klurfan
- Neurosurgery, Clinical Neuroscience, Gothenburg University, Gothenburg, Sweden
| | - Erik Kronvall
- Neurosurgery, Clinical Sciences, Lund University, Lund, Sweden
| | - Peter Lindvall
- Neurosurgery, Clinical Sciences, Umea University, Umeå, Sweden
| | | | - Ola G. Nilsson
- Neurosurgery, Clinical Sciences, Lund University, Lund, Sweden
| | - Mikael Svensson
- Neurosurgery, Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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Wang L. Letter to the Editor Regarding "Impact of Obesity and Diabetes on Postoperative Outcomes Following Surgical Treatment of Nontraumatic Subarachnoid Hemorrhage: Analysis of the ACS-NSQIP Database". World Neurosurg 2022; 167:230. [PMID: 36793162 DOI: 10.1016/j.wneu.2022.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 10/31/2022]
Affiliation(s)
- Lesheng Wang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, the People's Republic of China.
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