Initial Clinical Status and Spot Sign Are Associated with Intraoperative Aneurysm Rupture in Patients Undergoing Surgical Clipping for Aneurysmal Subarachnoid Hemorrhage
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Initial Clinical Status and Spot Sign Are Associated with Intraoperative Aneurysm Rupture in Patients Undergoing Surgical Clipping for Aneurysmal Subarachnoid Hemorrhage. / Burkhardt, Jan-Karl; Neidert, Marian Christoph; Mohme, Malte; Seifert, Burkhardt; Regli, Luca; Bozinov, Oliver.
in: J NEUROL SURG PART A, Jahrgang 77, Nr. 2, 03.2016, S. 130-8.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Initial Clinical Status and Spot Sign Are Associated with Intraoperative Aneurysm Rupture in Patients Undergoing Surgical Clipping for Aneurysmal Subarachnoid Hemorrhage
AU - Burkhardt, Jan-Karl
AU - Neidert, Marian Christoph
AU - Mohme, Malte
AU - Seifert, Burkhardt
AU - Regli, Luca
AU - Bozinov, Oliver
N1 - Georg Thieme Verlag KG Stuttgart · New York.
PY - 2016/3
Y1 - 2016/3
N2 - OBJECTIVE: To assess clinical and radiographic risk factors for intraoperative aneurysm rupture (ioAR) during surgical clipping after aneurysmal subarachnoid hemorrhage (aSAH) and to analyze its influence on patient outcome.METHODS: Patient selection was based on a retrospective analysis of our prospective subarachnoid hemorrhage patient database including consecutive patients between January 2008 and August 2012 with aSAH undergoing microsurgical clipping. Demographic data, cardiovascular risk factors, preoperative radiologic aneurysm characteristics, as well as timing of surgery and preoperative severity grades (Hunt and Hess [HH], Fisher, World Federation of Neurological Societies [WFNS]), were collected from hospital charts and surgery videos and compared between patients with and without ioAR.RESULTS: Of 100 patients (38 men, 62 women) with a median age of 57.4 years (range: 23-85 years), ioAR occurred in 34 cases (34%). Univariate analyses showed that severity grades were significantly higher in the ioAR group (Fisher p = 0.012; HH p = 0.002; WFNS p = 0.023). IoAR was significantly associated with intracerebral hemorrhage (ICH) (23% versus 47%; p = 0.013) and the spot sign as an indicator of active bleeding within the ICH (0% vs 44%; p = 0.007). Multivariate analysis showed that HH was the only significant predictor of ioAR (p = 0.03; odds ratio: 2.3; 95% confidence interval, 1.1-5.0). With a mean follow-up of 17.6 months ( ± 16.6), Glasgow Outcome Scale score, mortality rate (12% versus 15%; p = 0.82), delayed cerebral ischemia (36% versus 38%; p = 0.51), and shunt dependency (32% versus 44%; p = 0.23) were comparable between the non-ioAR and ioAR group.CONCLUSIONS: Initial clinical status and spot sign were associated with ioAR during microsurgical clipping of ruptured aneurysms. However, there was no difference regarding clinical outcome and complications of the two groups.
AB - OBJECTIVE: To assess clinical and radiographic risk factors for intraoperative aneurysm rupture (ioAR) during surgical clipping after aneurysmal subarachnoid hemorrhage (aSAH) and to analyze its influence on patient outcome.METHODS: Patient selection was based on a retrospective analysis of our prospective subarachnoid hemorrhage patient database including consecutive patients between January 2008 and August 2012 with aSAH undergoing microsurgical clipping. Demographic data, cardiovascular risk factors, preoperative radiologic aneurysm characteristics, as well as timing of surgery and preoperative severity grades (Hunt and Hess [HH], Fisher, World Federation of Neurological Societies [WFNS]), were collected from hospital charts and surgery videos and compared between patients with and without ioAR.RESULTS: Of 100 patients (38 men, 62 women) with a median age of 57.4 years (range: 23-85 years), ioAR occurred in 34 cases (34%). Univariate analyses showed that severity grades were significantly higher in the ioAR group (Fisher p = 0.012; HH p = 0.002; WFNS p = 0.023). IoAR was significantly associated with intracerebral hemorrhage (ICH) (23% versus 47%; p = 0.013) and the spot sign as an indicator of active bleeding within the ICH (0% vs 44%; p = 0.007). Multivariate analysis showed that HH was the only significant predictor of ioAR (p = 0.03; odds ratio: 2.3; 95% confidence interval, 1.1-5.0). With a mean follow-up of 17.6 months ( ± 16.6), Glasgow Outcome Scale score, mortality rate (12% versus 15%; p = 0.82), delayed cerebral ischemia (36% versus 38%; p = 0.51), and shunt dependency (32% versus 44%; p = 0.23) were comparable between the non-ioAR and ioAR group.CONCLUSIONS: Initial clinical status and spot sign were associated with ioAR during microsurgical clipping of ruptured aneurysms. However, there was no difference regarding clinical outcome and complications of the two groups.
KW - Journal Article
U2 - 10.1055/s-0035-1558414
DO - 10.1055/s-0035-1558414
M3 - SCORING: Journal article
C2 - 26216733
VL - 77
SP - 130
EP - 138
JO - J NEUROL SURG PART A
JF - J NEUROL SURG PART A
SN - 2193-6315
IS - 2
ER -