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Tasiou A, Brotis AG, Paschalis T, Tzerefos C, Kapsalaki EZ, Giannis T, Tzannis A, Fountas KN. Intermediate surgical outcome in patients suffering poor-grade aneurysmal subarachnoid hemorrhage. A single center experience. Int J Neurosci 2020; 132:38-50. [PMID: 32746674 DOI: 10.1080/00207454.2020.1801676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND It is known that patients suffering poor-grade aneurysmal subarachnoid hemorrhage (aSAH) have a dismal prognosis. The importance of early intervention is well established in the pertinent literature. Our aim was to assess the functional outcome and overall survival of these patients undergoing surgical clipping. MATERIAL AND METHODS In the current retrospective study we included all consecutive poor-grade patients after spontaneous SAH who presented at our institution over an eight-year period. All participants suffering SAH underwent brain CT angiography (CTA) to identify the source of hemorrhage. We assessed the severity of hemorrhage according to the Fisher grade classification scale. All patients were surgically treated. The functional outcome was evaluated six months after the onset with the Glasgow Outcome Scale. Finally, we performed logistic and Cox regression analyses to identify potential prognostic risk factors. RESULTS Our study included twenty-three patients with a mean age of 53 years. Five (22%) patients presented with Hunt and Hess grade IV, and eighteen (78%) with grade V. The mean follow-up was 15.8 months, while the overall mortality rate was 48%. The six-month functional outcome was favorable in 6 (26%) patients. The vast majority of our patients died between the 15th and the 60th post-ictal days. We did not identify any statistically significant prognostic factors related to the patient's outcome and/or survival. CONCLUSIONS Poor-grade aSAH patients may have a favorable outcome with proper surgical management. Large-scale studies are necessary for accurately outlining the prognosis of this entity, and identifying parameters that could be predictive of outcome.
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Affiliation(s)
- Anastasia Tasiou
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Alexandros G Brotis
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Thanasis Paschalis
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Christos Tzerefos
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Eftychia Z Kapsalaki
- Department of Neuroradiology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Theofanis Giannis
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Alkiviadis Tzannis
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Kostas N Fountas
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
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Dhandapani S, Singh A, Singla N, Praneeth K, Aggarwal A, Sodhi HB, Pal SS, Goudihalli S, Salunke P, Mohindra S, Kumar A, Gupta V, Chhabra R, Mukherjee KK, Tewari MK, Khandelwal N, Mathuriya SN, Khosla VK, Gupta SK. Has Outcome of Subarachnoid Hemorrhage Changed With Improvements in Neurosurgical Services? Stroke 2019; 49:2890-2895. [PMID: 30571395 DOI: 10.1161/strokeaha.118.022865] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background and Purpose- Though reports suggest decreasing fatality rates of subarachnoid hemorrhage with time, trends in outcome are not reported much especially from developing countries. This study was to analyze changes in outcome across 2 decades and elucidate probable factors. Methods- Prospective databases during 1996 to 2015 were reviewed for neurological outcome at 3 months in relation to demographics, Hunt and Hess grade, Fisher grade, and definitive treatment; and compared between 2 decades, contrasted by establishment of intensive care unit with continuous monitoring and other advancements. Univariate and multivariate analyses were performed. Results- Of the total 2039 patients, 1035 were managed in the former and 1004 in the recent decades. Compared with the former decade, there is delayed age at presentation (46 versus 49 years, P<0.001), poorer Fisher grades (81% versus 87%, P<0.001), and more patients with Hunt and Hess grade 2 (24% versus 39%, P<0.001) in the recent decade. While all patients in databases of the former decade had undergone clipping, 6% in the recent decade underwent coiling. 11% in the recent decade could not undergo definitive treatment. Despite this, there was significantly higher overall favorable outcome (50% versus 60%; odds ratio, 1.5; P<0.001) in recent decade. Favorable outcome of surgical clipping per se improved significantly from 50% to 67% (odds ratio 2.0; P<0.001). Though the improvement was across subgroups, it was more marked among Hunt and Hess grade 3 and Fisher grades 3 and 4. In multivariate analyses, both overall outcome (adjusted odds ratio, 1.7; 95% CI, 1.4-2.1; P<0.001) and surgical outcome (adjusted odds ratio, 1.8; 95% CI, 1.5-2.2; P<0.001) were significantly better in recent decade, independent of known prognostic factors. Conclusions- This is probably the first report to show independent improvement in outcome of subarachnoid hemorrhage with betterment in neurosurgical services from developing country. Dedicated intensive care unit care and focused management protocols could be the likely causes for improvement. Resource-constrained institutions may target patients in Hunt and Hess grade 3 and Fisher grades 3 and 4 for optimal intensive care unit utilization.
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Affiliation(s)
- Sivashanmugam Dhandapani
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Apinderpreet Singh
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Navneet Singla
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Kokkula Praneeth
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Ashish Aggarwal
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Harsimrat B Sodhi
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sudhir S Pal
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sachin Goudihalli
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Pravin Salunke
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sandeep Mohindra
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Ajay Kumar
- Department of Neuroradiology (N.K., A.K., V.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Vivek Gupta
- Department of Neuroradiology (N.K., A.K., V.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Rajesh Chhabra
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Kanchan K Mukherjee
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Manoj K Tewari
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Niranjan Khandelwal
- Department of Neuroradiology (N.K., A.K., V.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Suresh N Mathuriya
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Virender K Khosla
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sunil K Gupta
- From the Department of Neurosurgery (S.D., A.S., N.S., K.P., A.A., H.B.S., S.S.P., S.G., P.S., S.M., R.C., K.K.M., M.K.T., S.N.M., V.K.K., S.K.G.), Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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