Department of Neurosurgery, Showa General Hospital, Tokyo, Japan.
Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.
Neurosurg Rev. 2024 Oct 30;47(1):829. doi: 10.1007/s10143-024-03067-8.
This study aimed to evaluate age as a prognostic factor and develop a comprehensive prognostic model for patients undergoing clipping surgery for World Federation of Neurosurgical Societies (WFNS) grade I/II aneurysmal subarachnoid haemorrhage (SAH). We retrospectively investigated 188 patients with WFNS grade I/II SAH who underwent microsurgical clipping at our institute between December 2010 and January 2020. The data of 176 patients (75 with grade I and 101 with grade II) were analysed. Data on patient demographics, aneurysm characteristics, SAH factors, surgical details, and clinical outcomes were collected. Prognostic factors were assessed using bivariate and multivariable logistic regression analyses, and recursive partitioning analysis. Favourable outcomes (mRS 0-2) were observed in 76% of patients. Age, a significant negative prognostic factor in multivariable analysis (odds ratio 0.55, 95% confidence interval 0.40-0.76, p < 0.001), was cutoff at 70 years by the receiver operating characteristic curve. Patients aged ≤ 70 years had significantly better outcomes than those aged > 70 years (84% vs. 46%, respectively; p < 0.001). Epileptic seizures were significantly associated with poor outcomes in older adults (p < 0.001). A prognostic model (favourable, intermediate, and poor) based on age and postoperative adverse events showed significantly different outcomes between age groups (p < 0.001). Age was a stronger prognostic factor than WFNS grading for patients with grade I/II SAH undergoing microsurgical clipping. For patients aged ≤ 70 years, precise microsurgeries with fewer complications were associated with favourable outcomes beyond WFNS grade. For older patients, postoperative intensive seizure management may prevent poor outcomes.
本研究旨在评估年龄作为预后因素，并为 WFNS 分级 I/II 颅内动脉瘤性蛛网膜下腔出血（SAH）患者的夹闭手术制定综合预后模型。我们回顾性研究了 2010 年 12 月至 2020 年 1 月在我院接受显微夹闭手术的 188 例 WFNS 分级 I/II SAH 患者。分析了 176 例患者（75 例为 I 级，101 例为 II 级）的数据。收集了患者人口统计学、动脉瘤特征、SAH 因素、手术细节和临床结果的数据。使用双变量和多变量逻辑回归分析以及递归分区分析评估预后因素。76%的患者预后良好（mRS0-2）。年龄是多变量分析中的显著负预后因素（优势比 0.55，95%置信区间 0.40-0.76，p<0.001），通过接收者操作特征曲线截点为 70 岁。年龄≤70 岁的患者预后明显优于年龄>70 岁的患者（分别为 84%和 46%；p<0.001）。癫痫发作与老年人预后不良显著相关（p<0.001）。基于年龄和术后不良事件的预后模型（良好、中等和不良）显示，年龄组之间的预后差异有统计学意义（p<0.001）。年龄是 WFNS 分级 I/II SAH 患者接受显微夹闭手术的更强预后因素。对于年龄≤70 岁的患者，在 WFNS 分级之外，精确的、并发症较少的显微手术与良好的预后相关。对于老年患者，术后加强癫痫发作管理可能预防不良结局。
