重症くも膜下出血の分類と治療成績 : 続報(<特集>重症くも膜下出血の急性期治療)  [in Japanese] Current Surgical Outcome in Poor Grade Patients with Subarachnoid Hemorrhage(<Topics>Management of Severe Subarachnoid Hemorrhage)  [in Japanese]

Our prior studies revealed that favorable outcome occurred in 54% of WFNS Grade IV and 14% of Grade V patients with subarachnoid hemorrhage (SAH). To predict the outcome in patients with severe SAH, we assessed the outcome of the 192 poor-grade patients admitted to Asahikawa Red-Cross Hospital who suffered aneurysmal subarachnoid hemorrhage in the period of 1994 to 2001. Preoperative GCS with 3 and 6 presented approximately 20% of favorable outcome. None of the patients with preoperative GCS 4 or 5 presented favorable outcome. Seventy-nine patients were rated as SD (severely disabled) in GOS (Glasgow outcome scale). Three of 79 patients were rated SD because of focal sigh, such as aphasia or hemiparesis. The remaining cases revealed variable degrees of post SAH dementia. Using multivariate analysis, we found that the age (p< 0.001) and postoperative GCS (p<0.01) correlated with the outcome in SD patients. We conclude that aggressive management can benefit patients with GCS 3 or 6 even in Grade V. The outcome of the Grade V can be rated as "acceptable" in 28% when we include SD patients with acceptable deficit. In elderly patients 75 years old and older, our preliminary data suggest preoper-ative GCS with 8 or better may be the borderline to expect favorable outcome.