Article
Did aneurysm side influence patients' outcome from subarachnoid hemorrhage?
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Authors
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Nina Brawanski
- Klinik und Poliklinik für Neurochirurgie, Goethe- Universitätsklinkum Frankfurt, Frankfurt , Deutschland
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Sae-Yeon Won
- Neurochirurgie, Frankfurt, Deutschland
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Stephanie Tritt
- Institut für Neuroradiologie, Neuroradiologie, Bad Homburg, Deutschland
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Sepide Kashefiolasl
- Neurochirurgie, Goethe- Universität Frankfurt am Main, Frankfurt, Deutschland
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Christian Senft
- Universitätsklinikum Frankfurt, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt/Main, Deutschland
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Volker Seifert
- Johann Wolfgang Goethe-Universität, Klinik und Poliklinik für Neurochirurgie, Frankfurt/Main, Deutschland
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Jürgen Konczalla
- Goethe-Universitätsklinikum, Klinik und Poliklinik für Neurochirurgie, Frankfurt, Deutschland
| Published: | June 9, 2017 |
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Outline
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Objective: There seem to be differences in prognostic factors and outcome dependent on different aneurysm locations. Additionally factors like an existing concomitant intracerebral hemorrhage or probable infarctions due to surgical approach or endovascular catheterization are known as factors influencing patients´ outcome. Therefore we compared left- and right-sided aneurysms in patients with aneurysmal SAH in our department relating to differences in outcome and prognostic factors. Additionally we question, if infarctions in dominant hemisphere may significantly convert patients' outcome after aneurysmal SAH.
Methods: Patients with SAH were entered into a prospectively collected database (since 1999). A total of 506 patients with aneurysmal subarachnoid hemorrhage were retrospectively selected and divided in two groups depending on side of ruptured aneurysm (right n = 284 vs. left n=222). Outcome was assessed using the modified Rankin Scale (mRS; favorable (mRS 0-2) vs. unfavorable (mRS 3-6)) six months after SAH.
Results: Comparing outcome in patients with left- and right-sided ruptured aneurysms showed no significant statistical difference. Also mortality rate in our patients in both groups was similar (14.4% vs. 15.8%). In both examined patient groups statistically significant prognostic factors for a later favorable outcome were clinical admission status (WFNS I-III), Fisher 3- bleeding pattern in CT, the occurrence of severe CVS, an existing early hydrocephalus and later shunt- dependence. Side of ruptured aneurysm itself had no influence of patients´ outcome. Comparing patients with aneurysms of right and left side also showed no statistical significant differences concerning outcome and prognostic factors (favorable outcome right 61% vs. left 56%, death right 14% vs. left 16%).
Conclusion: Comparing outcome in patients with left- and right-sided ruptured aneurysms showed no significant statistical difference. Therefore, aneurysm side and possible complications seems not to affect patients’ outcome. In both examined patient groups statistically significant prognostic factors for a later favorable outcome were clinical admission status (WFNS I-III), Fisher 3-bleeding pattern in CT, the occurrence of severe CVS, an existing early hydrocephalus and later shunt-dependence.
