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Acta Neurochirurgica
Published in: Acta Neurochirurgica 4/2019

01-04-2019 | Subarachnoid Hemorrhage | Original Article - Vascular Neurosurgery - Aneurysm

Hemorrhagic burden in poor-grade aneurysmal subarachnoid hemorrhage: a volumetric analysis of different bleeding distributions

Authors: Pietro Panni, Elisa Colombo, Carmine Antonio Donofrio, Lina Raffaella Barzaghi, Luigi Albano, Claudio Righi, Francesco Scomazzoni, Franco Simionato, Pietro Mortini, Andrea Falini, Nicoletta Anzalone

Published in: Acta Neurochirurgica | Issue 4/2019

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Abstract

Background

Volumetric assessment of aneurysmal bleeding has been evaluated in few studies and emerged as a promising outcome predictor. There is a lack of studies evaluating its impact in the poor-grade population.

Methods

Retrospective review of 63 consecutive poor-grade aneurysmal subarachnoid hemorrhage (aSAH) patients, defined as grade IV and V according to the World Federation of Neurological Surgeons (WFNS) classifications. Global intracranial bleeding volume was calculated with its subarachnoid, intracerebral (ICH), and intraventricular (IVH) portions by means of analytical software. Univariate and multivariate analyses were performed in order to identify independent predictors of outcome. Good outcome was defined as modified Rankin Scale (mRS) 0–2 and mortality as mRS 6. The cutoff values of bleeding volumes were derived by receiver operating curve (ROC) analysis.

Results

Mean follow-up was of 12.5 (± 1.5) months. Thirty (47.7%) patients achieved good outcome, whereas 19 (30.2) patients out of 63 died. Global intracranial bleeding resulted as an independent predictor of good outcome (cutoff 24 mL). Furthermore, ICH relative percentage of global volume (10% of total) and pure SAH (64% of total) emerged respectively as independent predictors of worsened and improved outcome. Global bleeding volume (cutoff 51 mL) along with global cerebral edema showed to independently predict mortality in the examined poor-grade aSAH population.

Conclusions

Volumetric assessment of aneurysmal bleeding has the potential for identifying cutoff values that independently predict outcome. Further insights into the relative importance of different bleeding volumes may be implicated in better tailoring the management of this dismal aSAH population.
Appendix
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Metadata
Title
Hemorrhagic burden in poor-grade aneurysmal subarachnoid hemorrhage: a volumetric analysis of different bleeding distributions
Authors
Pietro Panni
Elisa Colombo
Carmine Antonio Donofrio
Lina Raffaella Barzaghi
Luigi Albano
Claudio Righi
Francesco Scomazzoni
Franco Simionato
Pietro Mortini
Andrea Falini
Nicoletta Anzalone
Publication date
01-04-2019
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 4/2019
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-019-03846-z

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