Publication year: 2011
Source: World Neurosurgery, Available online 10 December 2011
Fon-Yih Tsuang, Jo-Yu Chen, Chung-Wei Lee, Chien-Hsun Li, Jing-Er Lee, ...
ObjectOutcomes in poor-grade subarachnoid hemorrhage (SAH) patients may be better than those previously reported because of aggressive modern multidisciplinary management. Our purpose was to determine whether perfusion computed tomography (PCT) is useful for identifying those patients with reversible etiologies and whether early obliteration in poor-grade aneurysmal SAH leads favorable outcomes.MethodsPatients with new-onset aneurysmal SAH in World Federation of Neurological Surgeons (WFNS) grade IV or V neurological condition who had PCT performed at admission were included in the study. Thirty-eight patients seen between January 2007 and July 2009 were retrospectively enrolled. The decision to have an early obliteration was made by the family after a discussion with the neurosurgeons, neurointensivists, and interventional radiologists. The functional outcomes were correlated with the Glasgow outcome scale (GOS) at 6 months and the quantitative PCT data were collected.ResultsTen grade IV (26%) and 28 grade V (74%) patients were included in this study. Nineteen patients (50%) had favorable outcomes, and the total mortality was 11 (29%). After a multivariate logistic regression analysis of the parameters, older age (odds ratio 1.104, p = 0.0317), bilateral prolonged mean transient time at the thalami (odds ratio 4.155, p = 0.0362) and early obliteration (odds ratio 0.098, p = 0.003) were predictive of poor outcome.ConclusionEarly bilateral prolonged mean transient time at the thalami and old age are associated with poor outcome. Early obliteration benefits a significant portion of SAH patients.
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