Factors Predicting Poor Outcome in a Surgically Managed Series of Multiple Intracranial Aneurysms

Abstract

Multiple factors are known to influence outcomes in single-aneurysm subarachnoid hemorrhage, such as Hunt and Hess (H&H) grade, hypertension, etc. We sought to assess the influence of individual risk factors on outcome in surgically managed patients with multiple intracranial aneurysm. A retrospective review of consecutive 780 patients of subarachnoid hemorrhage revealed multiple intracranial aneurysm in 63 patients with 146 aneurysms. Clinicoradiologic features, hospital course, and outcome obtained via use of the Glasgow Outcome Score were noted from hospital records. H&H grade was divided into 2 groups as good and poor whereas Glasgow Outcome Score at 1 month was divided into 2 groups as favorable and unfavorable for analysis. To test association among variables, a χ(2) test/Fisher exact test was used. Risk was calculated in exposure group by the use of univariate logistic regression and multivariate analysis (binary logistic regression model). A definite female preponderance was observed (male/female ratio: 1:2.71). The most common site was middle cerebral artery bifurcation (overall and male patients, n= 43); in women, it was internal carotid artery bifurcation. Anterior communicating artery aneurysm was the most common to bleed (n= 22). Early presentation resulted in worse outcomes (<4: 4-21: >21days= 44:37:33, P= .844). Vasospasm and infarct incidence was greatest in the group 4-14 days (n= 37). Infarct evolved in 15 patients (8 in territory of aneurysmal dissection/distribution). Factors influencing patient outcomes were age ≥65 years (P= 0.037), H&H grade (P= 0.04), posterior communicating artery distribution of aneurysm (P= 0.03), hypertension (P= 0.03), infarct (P= 0.001), and hydrocephalus (P= 0.01) CONCLUSIONS: Poor H&H grade, hypertension, posterior communicating artery distribution, elderly age, infarct, and hydrocephalus each influenced poor outcomes at 1 month. Hydrocephalus is predictive of poor outcome.