SHORT- AND LONG-TERM OUTCOME OF SURGICALLY TREATED RUPTURED INTERNAL CAROTID ARTERY ANEURYSMS
Journal Title: Acta Neuropsychologica - Year 2013, Vol 11, Issue 4
Abstract
Most patients who survive a subarachnoid haemorrhage (SAH) leave hospital with a permanent neurological deficit. Factors influencing the short-term outcome and quality of life many years after surgery were not finally investigated. During the non-endovascular period there were 242 patients operated on for a ruptured internal carotid artery (ICA) aneurysm. The mean follow-up was 6.5 years. The Glasgow Outcome Scale (GOS), modified Rankin Scale (mRS) and SF-36 quality of life scale were used in the study. Demographic data, GCS, WFNS, Hunt-Hess and Fisher grade, the preoperative neurologic deficit, recognition of delayed cerebral ischemia (DCI) and the operative method were included in the analysis. The methods of outcome prediction consisted of logistic regression, receiver operating characteristic curves (ROC) and population attributable risk comparisons (PAR).At discharge, 68.4% of patients experienced moderate disability or good recovery, although 5.8% had no symptoms at all. Morbidity amounts to 41.7%. Unfavourable outcomes were attributed to older age, while morbidity by the presence of postoperative neurological deficit in multivariate analyses. Clinical signs of vasospasm (DCI), the Fisher and Hunt-Hess grade influenced both unfavourable outcome and morbidity. The Hunt-Hess scale was not a dominant component of the multivariate model of short-term outcome or morbidity. In the long-term follow-up, a high quality of life was established in 42.5% of patients. SF-36 differences were associated with age and gender.The factors influencing an unfavourable outcome differ from those determining morbidity. The Hunt-Hess scale is a dominant component of any short-term outcome prediction.
Authors and Affiliations
Tomasz Szmuda, Paweł Słoniewski, Przemyslaw Waszak, Michael Kindrachuk, Wiktor Olijewski
Keywords
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