1100. Functional outcomes after surgery for ruptured aneurysms

Authors: Vin Shen Ban, MD; Salah Aoun, MD; Tarek El Ahmadieh, MD; Rafael Sillero, MD; Juan Corona-Ruiz, MD; Awais Vance, MD; Duke Samson, MD; H. Hunt Batjer, MD; Jonathan White, MD; Babu Welch, MD (Dallas, TX)

Introduction:

Aneurysmal subarachnoid hemorrhage is associated with significant morbidity and mortality. Survival and meaningful neurological improvement are often unclear and challenging to predict, generating debate in the decision to treat and the choice of treatment modality. While endovascular options continue to expand, the role of surgery and its associated outcomes should be revisited.

Methods:

Patients were prospectively enrolled in the Southwestern Tertiary Aneurysm Registry. All patients with a ruptured aneurysm treated surgically between 2005 and 2014 were included. The primary outcome measure was the Glasgow Outcome Score (GOS) at 12 months. The Southwestern Aneurysm Severity Index (SASI) scores for each outcome were explored with the independent samples Median Test.

Results:

A total of 418 patients were identified (71.1% female, median age 53). GOS at discharge were 5, 4, 3, 2, and 1 in 17.5%, 16.3%, 58.4%, 1.2%, and 6.7% respectively. The GOS at 6 months were 5, 4, 3, 2, and 1 in 38.0%, 17.7%, 14.8%, 0.2%, and 9.1% respectively. At 12 months, these were 41.9%, 11.5%, 7.4%, 0.2%, and 10.5% respectively. The median SASI scores for GOS at 12 months of 5, 4, 3, and 1 were 10, 12, 15, and 17 respectively (p<0.001).

Conclusion:

Despite the devastating natural history of ruptured aneurysms, a substantial proportion of patients treated microsurgically experience meaningful neurological improvement over time. Appropriate patient selection will be crucial in achieving similar or superior outcomes.