Clinical Study of CT classifications of subarachnoid hemorrhage in ruptured anterior communicating aneurysms

Abstract

Objective To explore the characteristics of CT manifestations and their clinical application in subarachnoid hemorrhage (SAH) induced by ruptured anterior communicating aneurysms (ACoA). Methods A group of patients suffered from SAH with ruptured ACoA were reviewed from 1997 to 2013. A total of 405 ACoAs were clipped. According to the CT manifestations of the hemorrhage, SAH was classified into 5 types. Statistical analysis was performed to assess the relativity between this CT classification and the Hunt-Hess scale, the clinical outcomes as well as delayed cerebral ischemia(DCI). Results Among 279 cases ofⅠ-Ⅲ types, 266 cases (95.3%) were cured, 8 (2.9%) died. Among 126 cases of Ⅳ-Ⅴ types, 93 cases(73.8%) were cured, 19 (15.1%) died. The CT classification (Ⅰ-Ⅴ) was positively correlated with the patients′ prognosis (cure - death)(P<0.01), which became poor with the gradual increase of CT classification. Among 279 cases ofⅠ-Ⅲ types, 267 cases(95.7%) were Hunt - Hess classification levels (Ⅰ-Ⅲ) , 12(4.3%) were Hunt - Hess classification levels (Ⅳ - Ⅴ) . Among 126 cases of Ⅳ -Ⅴ types, 87 cases(69%) were Hunt - Hess classification levels (Ⅰ-Ⅲ), 39(31.0%) were Hunt - Hess classification levels (Ⅳ-Ⅴ) . The CT classification (Ⅰ-Ⅴ and the types with Hunt - Hess classification levels (Ⅰ-Ⅴ) were positively correlated(P<0.01). The morbidity of patients whose CT classifications wereⅠ-Ⅴ was 2.70%, 5.43%, 12.39%, 16.36% and 6.25% respectively. Conclusions The CT classifications of SAH in ruptured ACoA had comparatively higher Clinical value in predicting the patients′ prognosis. It should be noted that early diagnosis and microsurgical operation skills were important for the improvement of the patients′ prognosis. The CT classifications of SAH in ruptured ACoA which had guiding significance in predicting DCI had a good correlation with Hunt - Hess classification and the patients′ prognosis. Key words: Anterior communicating aneurysm; Subarachnoid hemorrhage; CT classifications; Clinical implication