Causes of Death in a Consecutive Series of 390 Surgically Treated Ruptured Intracranial Aneurysms

Abstract

Objective: To identify the main causes of death in a contemporary series of surgically treated patients with subarachnoid hemorrhage (SAH) and angiographically proven aneurysm. Methods: Since August 1989, 390 patients with aneurysmal SAH underwent surgery. Early surgery within 72 hours was possible in 309 patients, who had been admitted in time. In all patients, the out-come was assessed at discharge and after six month. Cases with a fatal outcome were studied in detail with respect to the clinical state pre- and postoperatively, the incidence of cerebral vasospasm as measured by transcranial Doppler sonography (TCD), and the postoperative neuroradiological investigations to identify the cause of death. Results: Thirty-three of the 390 surgically treated patients died during the follow-up period of six months, accounting for a post-operative mortality rate of 8.4%. The main cause of death was the effect of the initial hemorrhage in 18 patients (4.6%), followed by surgical complications in 6 patients (1.5%), vasospasm in 4 patients (1%), and medical complication in 4 patients (1%). In one patient, the available records did not allow to identify the cause of death. Conclusion: In the past two decades, re-rupture and vasospasm had been the leading causes of death in patients with aneurysmal SAH. Today, the effect of the hemorrhage is the main reason for a fatal outcome, which could be explained by the current policy to perform early surgery in good- as well as in poor-grade patients.