A New Scale(NS) Score System to Predict Outcome of Intracranial Aneurysm Using TCD.

Park, Sang Hoon; Park, Chong Oon; Park, Hyeon Seon; Hyun, Dong Keun; Ha, Young Soo

Original Article

Journal of Korean Neurosurgical Society 2001;30(8): 970-975.

Sang Hoon Park, Chong Oon Park, Hyeon Seon Park, Dong Keun Hyun, Young Soo Ha

Department of Neurosurgery, College of Medicine, Inha University, Sungnam, Korea.

ABSTRACT

OBJECTIVE
By conducing a review of clinical outcomes for patients with aneurysm treated using current microneurosurgical techniques and intensive care unit management, we speculated that grading systems based only on clinical condition or CT finding after admission failed to provide a significant stratification of outcome between individual grades of patients, because these systems did not include the factor for postoperative vasospasm. We hypothesized that postoperative blood flow velocity could have a significant impact on outcome prediction for patients surgically treated for intracranial aneurysms.
METHODS
We conducted a analysis on patient- and lesion-specific factors that might have been associated with outcome in a series of 55 aneurysm operations performed with measurements of blood-flow velocity with transcranial Doppler ultrasonography(TCD). In the new scale(NS) score system, 1 point is assigned additionally for the case with Hunt and Hess(H-H)/World Federation of Neurological Surgeons(WFNS) Grade IV or V, Fisher Scale(FS) score 3 or 4, aneurysm size greater than 10mm, patient age older than 60 years, blood-flow velocity higher than 120cm/sec, and posterior circulation lesion. By adding the total points, a 6-point scale score(score 0-6) is obtained.
RESULTS
Age of patient, size of aneurysm, clinical condition(H-H grade and WFNS), FS score, and blood flow velocity(TCD 1day after operation) were independently and strongly associated with long-term outcome. When NS scores were applied to 55 patients with at least 6 months follow-up, the correlation of individual scores with outcome was strongly validated the retrospective findings.
CONCLUSION
It was speculated that TCD could be used to assess postoperative vasospasm and to monitor noninvasively the patients with aneurysmal SAH. This NS score system is easy to apply, divide patients into groups with different outcome, and is comprehensive, allowing for more accurate prediction of surgical outcome.

Key Words: Aneurysm; Transcranial doppler ultrasonography; Outcome; Grading system