Turkish Neurosurgery
Prospective Analysis of Cerebral Edema Admission and Clinical Outcome in Ruptured Intracranial Aneurysm.
Dan Zimelewicz Oberman1, Nícollas Nunes Rabelo2, Leonardo Zumerkorn Pipek3, Joao Paulo Mota Telles3, Natalia Camargo Barbat3, Antônio Carlos Samaia da Silva Coelho3, Marcia Harumy Yoshikawa3, Guilherme Bittencourt Barbosa3, Manoel Jacobsen Teixeira2, Eberval Gadelha Figueiredo2
1Hospital Força Aérea do Galeão, Neurosurgery, Rio de Janeiro,
2University of São Paulo, Neurosurgery, São Paulo,
3Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo,
DOI: 10.5137/1019-5149.JTN.41935-22.2

Aim:Global cerebral edema (GCE) has become a neuroradiological marker of early brain injury after subarachnoid hemorrhage (SAH). Most clinical trials aimed to improve outcomes after SAH by understanding the pathophysiology mechanisms of early brain injury. We sought to evaluate the association between GCE after SAH and its impact on functional outcome evaluated by the modified Rankin scale. Material and Methods:This is a prospective cohort study with patients who were admitted to the hospital due to SAH. During the period from January 2018 to November 2019, 107 patients with intracranial aneurysms were enrolled. Using univariate and multivariate analysis, we sought to identify predictors and evaluated the impact of GCE on outcome after 6 months using the modified Rankin Scale (mRS).Results:GCE was present in 54 (50.5%) patients, of which 27 (25.2%) were mild, 20 (18.7%) moderate and 7 (6.5%) were severe. Univariate analysis identified high Hunt-Hess and Glasgow coma scale on clinical admission as predictors factors of GCE (p<0.05), and higher modified Fisher scale as a radiological predictor of Glasgow coma scale (p<0.05). Thirty-three (30.8%) patients were deceased at 6 months. Death or severe disability were predicted by higher age, poor clinical scale on admission and severe GCE (p<0.05).Conclusion:GCE on admission is independently associated with poor clinical outcomes at discharge and six months after SAH. Given its strong association with poor clinical grade on admission, GCE should be considered a straightforward and radiological important marker of early brain injury, with ominous implications.

Corresponding author : Dan Zimelewicz Oberman