The outcomes of early aneurysm repair in World Federation of Neurosurgical Societies grade V subarachnoid haemorrhage patients with emphasis on those presenting with a Glasgow Coma Scale score of 3

Joji Inamasu, Shunsuke Nakae, Tatsuo Ohmi, Hirotaka Kogame, Yushi Kawazoe, Tadashi Kumai, Riki Tanaka, Akira Wakako, Kiyonori Kuwahara, Tsukasa Ganaha, Yuichi Hirose

Research output: Contribution to journalArticle

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Abstract

Grade V subarachnoid haemorrhage (SAH) patients may be dichotomised into those with temporary deterioration and those with irreversible injury, and only the former have a chance of favourable outcomes by aneurysm obliteration. One method of differentiating the two conditions is to wait and observe potential recovery for 12–48 hours. However, early rebleeding and non-convulsive seizures may occur during this period. In our institution, grade V SAH patients receive immediate treatment (general anaesthesia induction and aneurysm obliteration within 24 hours of onset) to minimise those risks. We focused on therapeutic outcomes in SAH patients presenting with a Glasgow Coma Scale score of 3 (GCS-3). Between January 2006 and December 2013, 82 GCS-3 SAH patients were admitted, among whom 51 (62%) underwent immediate aneurysm obliteration. Their outcomes 90 days after onset were evaluated with the Glasgow Outcome Scale, with either good recovery or moderate disability regarded as favourable outcomes. Multivariate logistic regression analysis was performed to identify variables correlated with favourable outcomes. Among the 51 patients, 11 (22%) had favourable 90-day outcomes. Age (odds ratio [OR], 0.838; 95% confidence interval [CI], 0.733–0.959; p = 0.010) and intact pupillary light reflex (OR, 21.939; 95% CI, 1.465–328.576; p = 0.025) were correlated with favourable outcomes. By contrast, neither intact respiratory pattern nor isocoric pupils was correlated with favourable outcomes. The current results indicate that vigorous intervention may be worth attempting in young GCS-3 SAH patients with intact pupillary light reflex. It remains unclear, however, whether the seemingly high frequency of favourable outcomes was truly due to reduction in early rebleeding or seizures.

Original languageEnglish
Pages (from-to)142-147
Number of pages6
JournalJournal of Clinical Neuroscience
Volume33
DOIs
Publication statusPublished - 01-11-2016

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Glasgow Coma Scale
Subarachnoid Hemorrhage
Aneurysm
Pupillary Reflex
Seizures
Odds Ratio
Confidence Intervals
Glasgow Outcome Scale
Light
Pupil
General Anesthesia
Logistic Models
Regression Analysis
Wounds and Injuries
Therapeutics

All Science Journal Classification (ASJC) codes

  • Neurology
  • Clinical Neurology
  • Physiology (medical)

Cite this

Inamasu, Joji ; Nakae, Shunsuke ; Ohmi, Tatsuo ; Kogame, Hirotaka ; Kawazoe, Yushi ; Kumai, Tadashi ; Tanaka, Riki ; Wakako, Akira ; Kuwahara, Kiyonori ; Ganaha, Tsukasa ; Hirose, Yuichi. / The outcomes of early aneurysm repair in World Federation of Neurosurgical Societies grade V subarachnoid haemorrhage patients with emphasis on those presenting with a Glasgow Coma Scale score of 3. In: Journal of Clinical Neuroscience. 2016 ; Vol. 33. pp. 142-147.
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abstract = "Grade V subarachnoid haemorrhage (SAH) patients may be dichotomised into those with temporary deterioration and those with irreversible injury, and only the former have a chance of favourable outcomes by aneurysm obliteration. One method of differentiating the two conditions is to wait and observe potential recovery for 12–48 hours. However, early rebleeding and non-convulsive seizures may occur during this period. In our institution, grade V SAH patients receive immediate treatment (general anaesthesia induction and aneurysm obliteration within 24 hours of onset) to minimise those risks. We focused on therapeutic outcomes in SAH patients presenting with a Glasgow Coma Scale score of 3 (GCS-3). Between January 2006 and December 2013, 82 GCS-3 SAH patients were admitted, among whom 51 (62{\%}) underwent immediate aneurysm obliteration. Their outcomes 90 days after onset were evaluated with the Glasgow Outcome Scale, with either good recovery or moderate disability regarded as favourable outcomes. Multivariate logistic regression analysis was performed to identify variables correlated with favourable outcomes. Among the 51 patients, 11 (22{\%}) had favourable 90-day outcomes. Age (odds ratio [OR], 0.838; 95{\%} confidence interval [CI], 0.733–0.959; p = 0.010) and intact pupillary light reflex (OR, 21.939; 95{\%} CI, 1.465–328.576; p = 0.025) were correlated with favourable outcomes. By contrast, neither intact respiratory pattern nor isocoric pupils was correlated with favourable outcomes. The current results indicate that vigorous intervention may be worth attempting in young GCS-3 SAH patients with intact pupillary light reflex. It remains unclear, however, whether the seemingly high frequency of favourable outcomes was truly due to reduction in early rebleeding or seizures.",
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The outcomes of early aneurysm repair in World Federation of Neurosurgical Societies grade V subarachnoid haemorrhage patients with emphasis on those presenting with a Glasgow Coma Scale score of 3. / Inamasu, Joji; Nakae, Shunsuke; Ohmi, Tatsuo; Kogame, Hirotaka; Kawazoe, Yushi; Kumai, Tadashi; Tanaka, Riki; Wakako, Akira; Kuwahara, Kiyonori; Ganaha, Tsukasa; Hirose, Yuichi.

In: Journal of Clinical Neuroscience, Vol. 33, 01.11.2016, p. 142-147.

Research output: Contribution to journalArticle

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AU - Inamasu, Joji

AU - Nakae, Shunsuke

AU - Ohmi, Tatsuo

AU - Kogame, Hirotaka

AU - Kawazoe, Yushi

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AU - Tanaka, Riki

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AU - Kuwahara, Kiyonori

AU - Ganaha, Tsukasa

AU - Hirose, Yuichi

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