Results of interdisciplinary management of 693 patients with aneurysmal subarachnoid hemorrhage: Clinical outcome and relevant prognostic factors

Objectives: Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high rates of morbidities and fatalities. The continuous evolution of neurosurgical, endovascular and neuro-intensive cares has improved the overall mortality. In this study we sought to evaluate the clinical outcome after aSAH from a single tertiary center. Patients and Methods: We retrospectively identified and reviewed all consecutive patients with aSAH treated at our center between 2007 and 2016. Records were made of the initial clinical and radiological findings, treatment modalities, medical complications and length of hospitalization as well as the early and most recent clinical outcome. Results: 693 consecutive patients with aSAH were reviewed (34.2% males, mean age 56.1 +/- 14.1 years). The mean diameter of the ruptured aneurysms was 5.8 +/- 3.6 mm. A total of 265 (38.2%) patients had poor Hunt and Hess (HH) grade. Supportive care was provided in 73 cases. Endovascular or surgical management of the ruptured aneurysm was performed in 77% and 23% of the remaining cases, respectively. Cerebral vasospasm (CVS) was recorded in 177 (25.5%) cases, of which 42.7% had poor outcome. There were 134 (19.3%) early mortalities. Good clinical outcome (mRS < 2) was achieved in 59.5% of the total cohort and 73.7% of the survivors). Variables with significant association with the clinical outcome included age at presentation, HH grade, early aneurysm re-rupture, parenchymal hemorrhage (PH) and MCA-aneurysms. There was a trend for worse outcome with larger ruptured aneurysms, CVS, and intraventricular hemorrhage. Conclusion: The management of aSAH remains challenging but good clinical outcome can be achieved in a substantial subset of patients. Age, initial clinical condition, early aneurysm re-rupture, PH and MCA-aneurysm are important prognostic factors. Early detection and appropriate treatment of CVS are crucial for successful management.