动脉瘤性蛛网膜下腔出血后脑血管痉挛和围术期容量治疗

背景 动脉瘤破裂蛛网膜下腔出血后脑血管痉挛(cerebral vasospasm,CVS)是一个常见而严重的并发症.CVS造成的继发性脑组织缺血或迟发性脑损伤严重影响患者的预后,是动脉瘤性蛛网膜下腔出血(aneurysm subarachnoid hemorrhage,aSAH)患者伤残和死亡的主要因素. 目的 探究围术期液体治疗和循环容量管理在aSAH后CVS预防和治疗中的有效性,为减少脑动脉瘤手术后CVS发生、改善预后提供参考. 内容 探究动脉瘤破裂蛛网膜下腔出血后CVS病因、病理生理以及如何选择合适的液体进行容量治疗和三高疗法来防治CVS的发生. 趋向 深入研究脑动脉瘤破裂出血后CVS的发病机制和探讨围术期液体治疗以及循环容量管理,为临床防治CVS提供新的思路和方法.     

经侧脑室短期反复应用尿激酶和维生素C在预防迟发性脑血管痉挛的临床研究

目的 观察经侧脑室短期反复应用尿激酶(UK)和维生素C(Vit C)，并行侧脑室外引流，对预防动脉瘤破裂后迟发性脑血管痉挛(DCVS)的效果。方法 发病后48h内，手术夹闭瘤颈和侧脑室外引流治疗FisherⅢ级动脉瘤破裂30例。经侧脑室注射UK和Vit C治疗15例，对照组15例，以迟发性神经功能损害作为症状性DCVS的诊断依据，评估预后。结果 UK和Vit C治疗组术后3～4d血凝块消失，无DCVS的发生，预后良好；对照组术后5～10d血凝块消失，6例预后良好，7例中度病残，2例死亡。结论 经侧脑室短期反复应用UK和Vit C及侧脑室外引流，对预防蛛网膜下腔出血(SAH)后DCVS有较好的疗效。     

破裂颅内动脉瘤早期手术治疗88例临床分析

颅内动脉瘤是临床上一种较为常见的脑血管疾病,其突发性破裂容易造成蛛网膜下腔出血[1].动脉瘤在破裂之后,其导致患者病情恶化与死亡的主要原因在于动脉瘤再破裂以及脑血管痉挛[2].对破裂的颅内动脉瘤进行早期手术夹闭是目前治疗该疾病的的主要方法之一.本文就破裂颅内动脉瘤的早期手术治疗方法与技术进行分析和探讨,旨在总结治疗该疾病的手术经验,具体报告如下.     

脑动脉瘤所致蛛网膜下腔出血的治疗

自发性蛛网膜下腔出血中．34％由脑动脉瘤破裂造成的，蛛网膜下腔出血是造成脑血管痉挛（CVS）、导致患者死亡和多种并发症的直接原因．因此在脑动脉瘤破裂病人的治疗中．加快血性脑脊液的吸收是良好预后的关键。电解可脱式弹簧网（GDC）栓塞术在不开颅情况下，闭塞动脉瘤，防止再山血，较之传统开颅手术创伤小、恢复快，但无法清除蛛网膜下腔的血性脑脊液。笔者采用动脉瘤栓塞后的微导管、枕大池置管注射尿激酶溶解血凝块．及持续引流的方法治疗．取得满意疗效。现总结如下。     

蛛网膜下腔出血术后迟发性脑缺血的临床分析

目的分析动脉瘤性蛛网膜下腔出血术后迟发性脑缺血的临床影响。方法 2016年5月至2019年6月期间,回顾性连续纳入在本院接受治疗的190例动脉瘤性蛛网膜下腔出血患者,分析迟发性脑缺血的影响因素及不同时间内血栓最大振幅(MA)值和凝血指数(CI)值的变化。结果迟发性脑缺血独立危险因素为低钠血症、低白蛋白血症、改良Fisher分级≥Ⅲ级、Hunt-Hess分级≥Ⅲ级及WFNS分级≥Ⅳ级。在PBD5、PBD10和PBD15时,观察组的MA值和CI值明显高于对照组,差异具有统计学意义(P0.05),而在PBD1时,两组MA和CI值差异无统计学意义(P0.05)。结论 MA值和CI值可有效预测迟发性脑缺血的发生情况。而低钠血症、低血红蛋白、手术时机及脑水肿等是迟发性脑缺血的独立危险因素。     

动脉瘤性蛛网膜下腔出血患者血清sICAM-1含量变化的动态研究

目的研究动脉瘤性蛛网膜下腔出血（SAH）患者血清可溶性黏附分子-1（sICAM-1）的动态变化规律。方法对30例动脉瘤性蛛网膜下腔出血病人术前、术后1～3d、7～9d、13～15d血清sICAM-1进行动态观察，用TCD检测大脑中动脉血流速度（VMCA）。结果动脉瘤性蛛网膜下腔出血患者血清sICAM-1在术后1～3d、7～9d各均值明显高于对照组，尤以术后7～9d变化最明显；术前、术后有脑血管痉挛组和非脑血管痉挛组差异也有统计学意义。结论动脉瘤性蛛网膜下腔出血患者血清sICAM-1含量与病情演变、脑血管痉挛（CVS）程度有关。     

脑膜中动脉创伤性假性动脉瘤破裂致脑内出血：病例报告和文献回顾

创伤性假性动脉瘤占颅内动脉瘤的比例不到1%[1,2],而脑膜中动脉创伤性假性动脉瘤更是比较少见,急性或者迟发性硬膜外血肿是最常见的临床表现[3]。但是也经常与硬膜下血肿或者蛛网膜下腔出血相关,脑膜中动脉创伤性假性动脉瘤破裂导致的脑内血肿是极为罕见的。     

血管腔内治疗在椎动脉夹层动脉瘤中的应用体会

目的总结血管腔内治疗在椎动脉夹层动脉瘤中的应用体会,探讨不同动脉瘤的治疗策略。方法回顾性分析我科进行血管腔内治疗的10例椎动脉夹层动脉瘤病人的临床资料和治疗效果。结果 10例病人均为椎动脉夹层动脉瘤,其中破裂出血9例,未破裂1例,所有动脉瘤均成功采用血管腔内方法进行治疗:椎动脉内单支架辅助弹簧圈栓塞6例,椎动脉与小脑后下动脉双支架辅助弹簧圈栓塞3例,覆膜支架植入1例。术后因迟发性脑出血及硬膜下血肿死亡1例,发生脑梗塞1例。结论充分分析每个动脉瘤的影像特点,采用个体化的血管腔内治疗方式可以获得满意的治疗效果。     

外伤性迟发性颅内血肿临床特点及首次CT的影像学特征分析

目的分析外伤性迟发性颅内血肿临床特点及首次CT影像学特征,早期诊断外伤性迟发性颅内血肿,提高疗效。方法回顾性分析我院2005年至2009年经CT证实的外伤性迟发性颅内血肿患者的临床资料,总结临床特点和首次CT影像学特征。结果迟发性血肿多发生在伤后3d内,额颞部好发,老年人容易发生,进行性的意识水平下降或出现新的神经系统体征往往意味着迟发性血肿;首次CT发现头皮血肿、颅骨骨折、气颅、脑挫伤、蛛网膜下腔出血、外侧裂血肿等预警征象时,要警惕迟发性血肿的发生。结论如果首次CT扫描有头皮血肿、颅骨骨折、脑挫伤、蛛网膜下腔出血、外侧裂血肿者,或颅内血肿成功清除后,但临床症状和特征未改善甚至加重者,进行性的意识水平下降者,伤后应将头部CT动态扫描作为常规检查,做到早期诊断、及时治疗。     

外伤后迟发性脑积水的相关因素及预后分析 (附33例报告)

目的探讨外伤性脑积水的产生相关因素及与预后的关系。方法回顾性分析33例外伤后迟发性脑积水的临床特点、神经影像学特征及其与脑积水的关系以及预后。结果脑挫伤、蛛网膜下腔出血及脑室内出血出现迟发性脑积水比例分别为：36.4%、33.3%、27.3%。33例外伤后迟发性脑积水患者全部行侧脑室腹腔分流术,术后3个月随访,采用Salmon的六级预后评估法,达到＋3级者25例,达＋2级者4例,0级1例,-1级3例。结论伤后早期蛛网膜下腔及脑室内出血、颅骨缺损是迟发性脑积水发生的重要原因。侧脑室腹腔分流术是其常规、有效的外科治疗手段,大多数患者术后恢复良好。     

Current practice in neuropsychological outcome reporting after aneurysmal subarachnoid haemorrhage

Background

Neuropsychological deficits (NPD) are common in patients with aneurysmal subarachnoid haemorrhage (aSAH). NPD are one of the major limiting factors for patients with an otherwise acceptable prognosis for sustained quality of life. There are only a few studies reporting outcome after aSAH, which used a standardized neuropsychological test battery as a primary or secondary outcome measure. Aim of this study was to determine the current practice of reporting NPD following aSAH in clinical studies.

Methods

A MEDLINE analysis was performed using the search term “subarachnoid haemorrhage outcome”. The latest 1,000 articles were screened. We recorded study design, number of patients, and the presence of neuropsychological outcome report. Additionally, the time of testing after aSAH, the neuropsychological tests administered, as well as the percentage of patients with NPD were analyzed.

Results

A total of 324 publications between 2009 and 2012 were selected for further review. Of those, 21 studies (6.5%) reported neuropsychological outcome, in 2,001 of 346,666 patients (0.6%). The assessment of NPD differed broadly using both subjective and objective cognitive evaluation, and a large variety of tests were used.

Conclusion

Neuropsychological outcome is underreported, and there is great variety in assessment in currently published clinical articles on aSAH. Prospective randomized trials treating aSAH may benefit from implementing more comprehensive and standardized neuropsychological outcome measures. This approach might identify otherwise unnoticed treatment effects in future interventional studies of aSAH patients.     

Preclinical and clinical role of interleukin-6 in the development of delayed cerebral vasospasm and neuronal cell death after subarachnoid hemorrhage: towards a potential target therapy?

Delayed cerebral vasospasm (DCVS), early brain injury (EBI), and delayed cerebral ischemia (DCI) are devastating complications after aneurysmal subarachnoid hemorrhage (SAH). Interleukin (IL)-6 seems to be an important interleukin in the inflammatory response after SAH, and many studies describe a strong correlation between IL-6 and worse outcome. The aim of this study was to systematically review preclinical and clinical studies that evaluated systemic and cerebral IL-6 levels after SAH and their relation to DCVS, neuronal cell death, and DCI. We conducted two systematic literature searches using PubMed to identify preclinical and clinical studies evaluating the role of IL-6 after SAH. Suitable articles were selected based on predefined eligibility criteria following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 61 and 30 preclinical and clinical articles, respectively, were included in the systematic reviews. Of the preclinical studies in which IL-6 was measured in cerebrospinal fluid (CSF), parenchyma, and systemically, 100%, 94.4%, and 81.3%, respectively, showed increased expression of IL-6 after SAH. Preclinical results were mirrored by clinical findings in which elevated levels of IL-6 in CSF and plasma were found after SAH, correlating with DCVS, DCI, and worse outcome. Only two preclinical studies analyzed the direct inhibition of IL-6, which resulted in reduced DCVS and neuronal cell death. IL-6 is a marker of intracranial inflammation and plays a role in the pathophysiology of DCVS and DCI after SAH in preclinical animal models and clinical studies. Its inhibition might have therapeutic potential to improve the outcome of SAH patients.

     

Effects of fluid therapy following aneurysmal subarachnoid haemorrhage: a prospective clinical study

Blood transfusions and intravenous fluids are commonly employed as rescue therapy for delayed cerebral ischaemia following aneurysmal subarachnoid haemorrhage (aSAH). We sought to determine effects of various fluid supplements on clinical outcome in patients following aSAH. Clinical events and laboratory data of 160 aSAH patients were prospectively collected as part of 2 randomised controlled trials. Outcomes at discharge and at 6 months were measured with Glasgow Outcome Scale (GOS). Favourable outcome was defined as good recovery or moderate disability on GOS. All of the 160 patients received intravenous fluid supplements with crystalloids; 122 (76.3%) also received synthetic colloids (4% succinylated gelatine or 6% pentastarch). A higher daily dose of synthetic colloids for initial resuscitation seemed to be associated with more requirements for blood transfusions (p = 0.003) and occurrence of vasospasm in poor-grade patients (p = 0.081), but blood transfusions themselves were not associated with occurrence of vasospasm. Compared with patients not receiving synthetic colloids, those receiving synthetic colloids had increased haemodilution, elevated inflammatory profiles, and decreased duration and strength of intact cerebral autoregulation. Multivariate analyses identified that blood transfusions (odds ratio, OR 3.38, p = 0.035) were associated with unfavourable outcome at discharge. Colloid fluids (OR 2.53/L/day, p = 0.025) promoted unfavourable outcome at 6 months (OR 4.45, p = 0.035), while crystalloids decreased unfavourable outcome (OR 0.27/L/day, p = 0.005). Associations between synthetic colloids and crystalloids with GOS at 6 months were dose-related. Intravenous fluid therapy using synthetic colloids or blood transfusions may be associated with increased unfavourable outcome following aSAH.     

Baseline characteristics and outcome for aneurysmal versus non-aneurysmal subarachnoid hemorrhage: a prospective cohort study

This study aims to investigate the characteristics of patients with mild aneurysmal and non-aneurysmal perimesencephalic and non-perimesencephalic subarachnoid hemorrhage (aSAH, pmSAH, npmSAH) with emphasis on admission biomarkers, clinical course, and outcome. A prospective cohort of 115 patients with aSAH (Hunt and Hess 1–3) and of 35 patients without aneurysms (16 pmSAH and 19 npmSAH) admitted between January 2014 and January 2020 was included. Demographic data, blood samples on admission, complications (hydrocephalus, shunt dependency, delayed cerebral ischemia DCI, DCI-related infarction, and mortality), and outcome after 6 months were analyzed. Demographic data was comparable between all groups except for age (aSAH 55 [48–65] vs. npmSAH 60 [56–68] vs. pmSAH 52 [42–60], p?=?0.032) and loss of consciousness (33% vs. 0% vs. 0%, p?=?0.0004). Admission biomarkers showed poorer renal function and highest glucose levels for npmSAH patients. Complication rate in npmSAH was high and comparable to that of aSAH patients (hydrocephalus, shunt dependency, DCI, DCI-related infarction, mortality), but nearly absent in patients with pmSAH. Favorable outcome after 6 months was seen in 92.9% of pmSAH, 83.3% of npmSAH, and 62.7% of aSAH (p?=?0.0264). In this prospective cohort of SAH patients, npmSAH was associated with a complicated clinical course, comparable to that of patients with aSAH. In contrast, such complications were nearly absent in pmSAH patients, suggesting fundamental differences in the pathophysiology of patients with different types of non-aneurysmal hemorrhage. Our findings underline the importance for a precise terminology according the hemorrhage etiology as a basis for more vigilant management of npmSAH patients. NCT02142166, 05/20/2014, retrospectively registered.

     

Toll-like Receptor 4 (TLR4) is Associated with Cerebral Vasospasm and Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage

In the present prospective study, the Toll-like receptor 4 (TLR4) levels on peripheral blood mononuclear cells (PBMCs) were investigated in 30 patients with aneurysmal subarachnoid hemorrhage (aSAH) and in 20 healthy controls (HCs). The relationship between TLR4 levels and the occurrence of cerebral vasospasm (CVS) was also analyzed. TLR4 expression level on cell surface of PBMCs on days 1, 3, and 7 after admission was determined by flow cytometry. Results showed that patients with aSAH presented a significantly higher TLR4 levels. For patients with Hunt-Hess grades IV–V, higher TLR4 levels were also observed; higher TLR4 levels have already been seen in patients developing CVS and/or delayed cerebral ischemia (DCI). Higher TLR4 levels were also associated with modified Fisher score, occurrence of dCVS, DCI, cerebral infarction (CT), and poor neurological functional recovery. Binary logistic regression analysis indicated that high TLR4 expression on blood monocytes was an independent predictive factor of the occurrence of dCVS, DCI, and poor neurological functional recovery. Taken together, TLR4 levels on PBMCs is significantly altered in the early stage of aSAH, especially in those patients experiencing CVS and DCI. Furthermore, higher TLR4 levels in the early stage of aSAH is also associated with the neurological function outcome. As far as we know, this is the first clinical study about TLR4''s significance for patients with aSAH.     

Admission rate-pressure product as an early predictor for in-hospital mortality after aneurysmal subarachnoid hemorrhage

Early prediction of in-hospital mortality in aneurysmal subarachnoid hemorrhage (aSAH) is essential for the optimal management of these patients. Recently, a retrospective cohort observation has reported that the rate-pressure product (RPP, the product of systolic blood pressure and heart rate), an objective and easily calculated bedside index of cardiac hemodynamics, was predictively associated with in-hospital mortality following traumatic brain injury. We thus wondered whether this finding could also be generalized to aSAH patients. The current study aimed to examine the association of RPP at the time of emergency room (ER) admission with in-hospital mortality and its predictive performance among aSAH patients. We retrospectively included 515 aSAH patients who had been admitted to our ER between 2016 and 2020. Their baseline heart rate and systolic blood pressure at ER presentation were extracted for the calculation of the admission RPP. Meanwhile, we collected relevant clinical, laboratory, and neuroimaging data. Then, these data including the admission RPP were examined by univariate and multivariate analyses to identify independent predictors of hospital mortality. Eventually, continuous and ordinal variables were selected from those independent predictors, and the performance of these selected predictors was further evaluated and compared based on receiver operating characteristic (ROC) curve analyzes. We identified both low (<?10,000; adjusted odds ratio (OR) 3.49, 95% CI 1.93–6.29, p?<?0.001) and high (>?15,000; adjusted OR 8.42, 95% CI 4.16–17.06, p?<?0.001) RPP on ER admission to be independently associated with in-hospital mortality after aSAH. Furthermore, after centering the admission RPP by its median, the area under its ROC curve (0.761, 95% CI 0.722–0.798, p?<?0.001) was found to be statistically superior to any of the other independent predictors included in the ROC analyzes (all p?<?0.01). In light of the predictive superiority of the admission RPP, as well as its objectivity and easy accessibility, it is indeed a potentially more applicable predictor for in-hospital death in aSAH patients.

     

Prompt closure versus gradual weaning of external ventricular drainage for hydrocephalus following aneurysmal subarachnoid haemorrhage: Protocol for the DRAIN randomised clinical trial

Background

Aneurysmal subarachnoid haemorrhage (aSAH) is a life-threatening disease caused by rupture of an intracranial aneurysm. A common complication following aSAH is hydrocephalus, for which placement of an external ventricular drain (EVD) is an important first-line treatment. Once the patient is clinically stable, the EVD is either removed or replaced by a ventriculoperitoneal shunt. The optimal strategy for cessation of EVD treatment is, however, unknown. Gradual weaning may increase the risk of EVD-related infection, whereas prompt closure carries a risk of acute hydrocephalus and redundant shunt implantations. We designed a randomised clinical trial comparing the two commonly used strategies for cessation of EVD treatment in patients with aSAH.

Methods

DRAIN is an international multi-centre randomised clinical trial with a parallel group design comparing gradual weaning versus prompt closure of EVD treatment in patients with aSAH. Participants are randomised to either gradual weaning which comprises a multi-step increase of resistance over days, or prompt closure of the EVD. The primary outcome is a composite outcome of VP-shunt implantation, all-cause mortality, or ventriculostomy-related infection. Secondary outcomes are serious adverse events excluding mortality, functional outcome (modified Rankin scale), health-related quality of life (EQ-5D) and Fatigue Severity Scale (FSS). Outcome assessment will be performed 6 months after ictus. Based on the sample size calculation (event proportion 80% in the gradual weaning group, relative risk reduction 20%, type I error 5%, power 80%), 122 patients are needed in each intervention group. Outcome assessment for the primary outcome, statistical analyses and conclusion drawing will be blinded.

Trial Registration

ClinicalTrials.gov identifier: NCT03948256.     

Visual field findings after a ruptured intracranial aneurysm

Background

Visual field defects (VFDs) negatively affect activities of daily living and rehabilitation following aneurysmal subarachnoid haemorrhage (aSAH). The aim here was to assess VFDs in patients with aSAH and their associations with age, gender, aSAH severity, and clinical outcome.

Methods

Patients admitted to Helsinki University Central Hospital and treated during 2011 were participants in this prospective study. Findings obtained with the Octopus 900 perimeter (Haag-Streit Inc, Koenic, Switzerland), the Goldmann perimeter (Haag-Streit Inc, Bern, Switzerland), or the confrontation visual field test on admission and 3 days, 14 days, 2 to 4 months, and 6 months postoperatively were assigned to 16 classes. Associations between post-chiasmal VFDs and relevant clinical, radiological, and demographic data were analysed with uni- and multivariate logistic regression.

Results

Of 105 survivors at 6 months, 20 (19 %) had VFDs occurring for aneurysm- or operation-related reasons; homonymous hemianopias or quadrantanopias were the most common finding, occurring in 16 patients (15 %). Posterior ischaemic optic neuropathy presented in two patients (2 %). Ten survivors (10 %) no longer fulfilled visual field requirements for driving licences. Significant associations emerged between VFDs at 6 months and the Hunt and Hess (H&H), World Federation of Neurosurgical Societies (WFNS), and Fisher grades on admission, presence of intracerebral haemorrhage (ICH), hydrocephalus, or postoperative infarction, and higher modified Rankin Scale scores at 6 months. Multivariate logistic regression showed the H&H grade and presence of ICH to independently predict VFDs.

Conclusions

Assessing VFDs is advisable, especially among patients with poor-grade aSAH (H&H grade IV or V) and ICH.     

Role of inflammation (leukocyte-endothelial cell interactions) in vasospasm after subarachnoid hemorrhage

BackgroundDelayed vasospasm is the leading cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). This phenomenon was first described more than 50 years ago, but only recently has the role of inflammation in this condition become better understood.MethodsThe literature was reviewed for studies on delayed vasospasm and inflammation.ResultsThere is increasing evidence that inflammation and, more specifically, leukocyte-endothelial cell interactions play a critical role in the pathogenesis of vasospasm after aSAH, as well as in other conditions including meningitis and traumatic brain injury. Although earlier clinical observations and indirect experimental evidence suggested an association between inflammation and chronic vasospasm, recently direct molecular evidence demonstrates the central role of leukocyte-endothelial cell interactions in the development of chronic vasospasm. This evidence shows in both clinical and experimental studies that cell adhesion molecules (CAMs) are up-regulated in the perivasospasm period. Moreover, the use of monoclonal antibodies against these CAMs, as well as drugs that decrease the expression of CAMs, decreases vasospasm in experimental studies. It also appears that certain individuals are genetically predisposed to a severe inflammatory response after aSAH based on their haptoglobin genotype, which in turn predisposes them to develop clinically symptomatic vasospasm.ConclusionBased on this evidence, leukocyte-endothelial cell interactions appear to be the root cause of chronic vasospasm. This hypothesis predicts many surprising features of vasospasm and explains apparently unrelated phenomena observed in aSAH patients. Therapies aimed at preventing inflammation may prevent and/or reverse arterial narrowing in patients with aSAH and result in improved outcomes.     

Development and Validation of Scoring Indication of Surgical Clipping and Endovascular Coiling for Aneurysmal Subarachnoid Hemorrhage from the Post Hoc Analysis of Japan Stroke Data Bank

There are no scoring methods for optimal treatment of patients with aneurysmal subarachnoid hemorrhage (aSAH). We developed a scoring model to predict clinical outcomes according to aSAH risk factors using data from the Japan Stroke Data Bank (JSDB). Of 5344 patients initially registered in the JSDB, 3547 met the inclusion criteria. Patients had been diagnosed with aSAH and treated with surgical clipping or endovascular coiling between 1998 and 2013. We performed multivariate logistic regression for poor outcomes at discharge, indicated by a modified Rankin Scale (mRS) score >2, and in-hospital mortality for both treatment methods. Based on each risk factor, we developed a scoring model assessing its validity using another dataset of our institution. In the surgical clipping group, scoring criteria for aSAH were age >72 years, history of more than once stroke, World Federation of Neurological Societies (WFNS) grades II–V, aneurysmal size >15 mm, and vertebrobasilar artery (VBA) aneurysm location. In the endovascular coiling group, scoring criteria were age >80 years, history of stroke, WFNS grades III–V, computed tomography (CT) Fisher group 4, and aneurysmal location in the middle cerebral artery (MCA) and anterior cerebral artery (ACA). The rates of poor outcome of mRS score >2 in an isolated dataset using these scoring criteria were significantly correlated with our model’s scores, so this scoring model was validated. This scoring model can help in the more objective treatment selection in patients with aSAH.