Impact of Clinical Variables and Aneurysm Morphology on Hemorrhage Volume and Clinical Outcomes

Andres Gudino; Elena Sagues; Carlos Dier; Sebastian Sanchez; Martin Cabarique; Navami Shenoy; Alexander Van Dam; Linder Wendt; Connor Aamot; Santiago Ortega-Gutierrez; Mario Zanaty; Edgar A Samaniego

doi:10.1227/neu.0000000000003567

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Impact of Clinical Variables and Aneurysm Morphology on Hemorrhage Volume and Clinical Outcomes

Journal article

Peer reviewed

Impact of Clinical Variables and Aneurysm Morphology on Hemorrhage Volume and Clinical Outcomes

Andres Gudino, Elena Sagues, Carlos Dier, Sebastian Sanchez, Martin Cabarique, Navami Shenoy, Alexander Van Dam, Linder Wendt, Connor Aamot, Santiago Ortega-Gutierrez, …

Neurosurgery, Vol.98(2), pp.394-403

02/2026

DOI: 10.1227/neu.0000000000003567

PMID: 40521903

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Abstract

It is unknown what determines the volume of aneurysmal subarachnoid hemorrhage (aSAH). We aimed to investigate the features associated to the burden of subarachnoid hemorrhage after aneurysm rupture and its impact on clinical outcomes. Patients admitted with aSAH between 2009 and 2022 were included. Clinical data were obtained from electronic medical records. Aneurysm location and morphological measurements were assessed using digital subtraction angiography. aSAH volume was objectively quantified on admission noncontrast computed tomography using semiautomated software. Univariate and multivariate analyses were performed to identify predictors of hemorrhage volume and examine its association with delayed cerebral ischemia (DCI), clinical vasospasm, and 7-day mortality in younger (18-64 years) and elderly (≥65 years) patients. Two hundred ruptured intracranial aneurysms were analyzed. Ruptured bifurcating aneurysms exhibited larger hemorrhage volume compared with sidewall aneurysms (23.16 mL, IQR: 34.2 vs 11.95 mL, IQR: 20.9, P = .002). In multivariate analysis, age (exp β 1.02; 95% CI 1.01-1.03; P < .001), Hunt and Hess (exp β 1.46, 95% CI: 1.31-1.62, P <.001), and bifurcation aneurysms (exp β 1.76; 95% CI 1.37-2.26; P <.001) were correlated with increased aSAH volume. Among younger patients, higher aSAH volume was associated with DCI (odds ratio [OR] 1.04; 95% CI 1.02-1.06; P < .001), clinical vasospasm (OR 1.02; 95% CI 1.01-1.03; P = .02), and 7-day mortality (OR 1.05; 95% CI 1.02-1.07; P < .001). In elderly population, larger aSAH was only associated with 7-day mortality (OR 1.04; 95% CI 1.01-1.07; P = .01). Older age, bifurcating aneurysms, and higher Hunt and Hess are associated with larger aSAH volumes. In younger patients, greater aSAH volume is linked to an increased risk of DCI, clinical vasospasm, and 7-day mortality. Among older patients, increased aSAH volume is only associated with 7-day mortality.

Demographical information

Aneurysm morphology

Aneurysmal subarachnoid hemorrhage

Clinical outcomes

Details

Title: Subtitle: Impact of Clinical Variables and Aneurysm Morphology on Hemorrhage Volume and Clinical Outcomes
Creators: Andres Gudino - University of Iowa
Elena Sagues - University of Iowa
Carlos Dier - University of Iowa
Sebastian Sanchez - Yale University
Martin Cabarique - Department of Neurology, University of Iowa, Iowa City, Iowa, USA
Navami Shenoy - University of Iowa
Alexander Van Dam - University of Iowa
Linder Wendt - University of Iowa
Connor Aamot - University of Iowa
Santiago Ortega-Gutierrez - University of Iowa
Mario Zanaty - University of Iowa
Edgar A Samaniego - University of Iowa
Resource Type: Journal article
Publication Details: Neurosurgery, Vol.98(2), pp.394-403
DOI: 10.1227/neu.0000000000003567
PMID: 40521903
NLM abbreviation: Neurosurgery
ISSN: 1524-4040
eISSN: 1524-4040
Grant note: Brain Aneurysm Foundation
Language: English
Electronic publication date: 06/16/2025
Date published: 02/2026
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984832188402771

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