{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,11]],"date-time":"2025-04-11T04:05:32Z","timestamp":1744344332151,"version":"3.40.4"},"reference-count":46,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,4,10]],"date-time":"2025-04-10T00:00:00Z","timestamp":1744243200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,4,10]],"date-time":"2025-04-10T00:00:00Z","timestamp":1744243200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Neurochir"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Metformin is widely prescribed and has neuroprotective effects in animals, but its impact on brain injury after aneurysmal subarachnoid hemorrhage (aSAH) in humans is unclear.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This single-center retrospective review assessed patients with aSAH from 2009 to 2023, categorizing them based on pre-admission metformin use. The primary outcome was delayed cerebral ischemia (DCI), while secondary outcomes included in-hospital mortality, rebleeding, angiographic cerebral vasospasm (CVS), and favorable modified Rankin Scale (mRS) scores at discharge and the 3-month follow-up. Outcomes were analyzed using logistic regression. Sensitivity analysis was performed after excluding patients receiving comfort care.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>A total of 900 patients were included (47 metformin and 853 non-metformin). DCI rates were similar between groups (38.3% vs. 29.3%, aOR =\u20091.06 [0.49\u20132.28]). Rebleeding rates were 4.3% for metformin users and 5.6% for non-users (aOR =\u20090.47 [0.09\u20132.51]). In-hospital mortality was 4.3% in metformin users vs. 9.7% in non-users (aOR =\u20090.47 [0.08\u20132.84]). Angiographic CVS was 38.3% in metformin users and 52.8% in non-users (aOR =\u20090.49 [0.23\u20131.05]), and at 7\u00a0days, CVS was 29.8% vs. 47.6% (aOR =\u20090.46 [0.21\u20131.01]). Sensitivity analysis showed similar DCI rates (39.1% vs. 30.9%, aOR =\u20090.98 [0.45\u20132.15]) but lower CVS at 7\u00a0days for metformin users (aOR =\u20090.44 [0.20\u20130.98]).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Metformin use before aSAH did not significantly affect the risk of DCI or CVS. However, after excluding comfort care patients, the findings are highly speculative of reduced CVS risk at 7\u00a0days post-aSAH. Rebleeding and mortality rates were similar across groups. Future research with larger, multi-institutional datasets is needed to better understand metformin's impact, particularly during and after aSAH.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00701-025-06516-5","type":"journal-article","created":{"date-parts":[[2025,4,10]],"date-time":"2025-04-10T08:08:35Z","timestamp":1744272515000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of metformin use on aneurysmal subarachnoid hemorrhage outcomes"],"prefix":"10.1007","volume":"167","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-6256-1624","authenticated-orcid":false,"given":"Angel","family":"Bueno","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4606-5646","authenticated-orcid":false,"given":"Andrea","family":"Becerril-Gaitan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1057-9448","authenticated-orcid":false,"given":"Collins","family":"Mokua","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6962-1227","authenticated-orcid":false,"given":"Kristina","family":"Ramirez-Garcia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0659-3256","authenticated-orcid":false,"given":"Justin","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4462-5232","authenticated-orcid":false,"given":"Faris","family":"Shaker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tien","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8041-8399","authenticated-orcid":false,"given":"Antonio","family":"Dono","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2902-5079","authenticated-orcid":false,"given":"Spiros","family":"Blackburn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8438-132X","authenticated-orcid":false,"given":"Peng Roc","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6999-438X","authenticated-orcid":false,"given":"Mark","family":"Dannenbaum","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7218-832X","authenticated-orcid":false,"given":"H. Alex","family":"Choi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arthur L.","family":"Day","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacques J.","family":"Morcos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7830-9273","authenticated-orcid":false,"given":"Ching-Jen","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,4,10]]},"reference":[{"issue":"2","key":"6516_CR1","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1007\/s12028-023-01812-3","volume":"39","author":"A Abdulazim","year":"2023","unstructured":"Abdulazim A, Heilig M, Rinkel G, Etminan N (2023) Diagnosis of delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage and triggers for intervention. Neurocrit Care 39(2):311\u2013319","journal-title":"Neurocrit Care"},{"issue":"3","key":"6516_CR2","doi-asserted-by":"publisher","first-page":"1107","DOI":"10.1007\/s10787-023-01163-7","volume":"31","author":"HM Al-Kuraishy","year":"2023","unstructured":"Al-Kuraishy HM, Al-Gareeb AI, Saad HM, Batiha GE-S (2023) Long-term use of metformin and Alzheimer\u2019s disease: beneficial or detrimental effects. Inflammopharmacology 31(3):1107\u20131115","journal-title":"Inflammopharmacology"},{"key":"6516_CR3","doi-asserted-by":"publisher","first-page":"101517","DOI":"10.1016\/j.redox.2020.101517","volume":"34","author":"N Apostolova","year":"2020","unstructured":"Apostolova N, Iannantuoni F, Gruevska A, Muntane J, Rocha M, Victor VM (2020) Mechanisms of action of metformin in type 2 diabetes: Effects on mitochondria and leukocyte-endothelium interactions. Redox Biol 34:101517","journal-title":"Redox Biol"},{"key":"6516_CR4","volume-title":"Medical Statistics: A Guide to SPSS","author":"B Barton","year":"2014","unstructured":"Barton B, Peat J (2014) Medical Statistics: A Guide to SPSS. John Wiley & Sons, Data Analysis and Critical Appraisal"},{"issue":"41","key":"6516_CR5","doi-asserted-by":"publisher","first-page":"e12769","DOI":"10.1097\/MD.0000000000012769","volume":"97","author":"A Basile-Filho","year":"2018","unstructured":"Basile-Filho A, Lago AF, Menegueti MG, Nicolini EA, Nunes RS, de Lima SL, Ferreira JPU, Feres MA (2018) The use of SAPS 3, SOFA, and Glasgow coma scale to predict mortality in patients with subarachnoid hemorrhage: a retrospective cohort study. Medicine 97(41):e12769","journal-title":"Medicine"},{"issue":"6","key":"6516_CR6","doi-asserted-by":"publisher","first-page":"1572","DOI":"10.1161\/STROKEAHA.123.045489","volume":"55","author":"A Becerril-Gaitan","year":"2024","unstructured":"Becerril-Gaitan A, Mokua C, Liu C et al (2024) Racial and ethnic differences in mortality and functional outcomes following aneurysmal subarachnoid hemorrhage. Stroke 55(6):1572\u20131581","journal-title":"Stroke"},{"key":"6516_CR7","doi-asserted-by":"publisher","first-page":"e1017","DOI":"10.1016\/j.wneu.2024.05.036","volume":"187","author":"A Becerril-Gaitan","year":"2024","unstructured":"Becerril-Gaitan A, Nguyen T, Liu C et al (2024) The effect of age on cerebral vasospasm and delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage. World Neurosurg 187:e1017\u2013e1024","journal-title":"World Neurosurg"},{"key":"6516_CR8","doi-asserted-by":"publisher","first-page":"113686","DOI":"10.1016\/j.biopha.2022.113686","volume":"156","author":"G Cao","year":"2022","unstructured":"Cao G, Gong T, Du Y, Wang Y, Ge T, Liu J (2022) Mechanism of metformin regulation in central nervous system: Progression and future perspectives. Biomed Pharmacother 156:113686","journal-title":"Biomed Pharmacother"},{"issue":"2","key":"6516_CR9","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1016\/j.arr.2011.01.001","volume":"10","author":"SC Correia","year":"2011","unstructured":"Correia SC, Santos RX, Perry G, Zhu X, Moreira PI, Smith MA (2011) Insulin-resistant brain state: the culprit in sporadic Alzheimer\u2019s disease? Ageing Res Rev 10(2):264\u2013273","journal-title":"Ageing Res Rev"},{"issue":"12","key":"6516_CR10","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1007\/s00234-009-0575-y","volume":"51","author":"JW Dankbaar","year":"2009","unstructured":"Dankbaar JW, Rijsdijk M, van der Schaaf IC, Velthuis BK, Wermer MJH, Rinkel GJE (2009) Relationship between vasospasm, cerebral perfusion, and delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. Neuroradiology 51(12):813\u2013819","journal-title":"Neuroradiology"},{"issue":"5","key":"6516_CR11","doi-asserted-by":"publisher","first-page":"e427","DOI":"10.1093\/neuros\/nyaa581","volume":"88","author":"G de Jong","year":"2021","unstructured":"de Jong G, Aquarius R, Sanaan B, Bartels RHMA, Grotenhuis JA, Henssen DJHA, Boogaarts HD (2021) Prediction models in aneurysmal subarachnoid hemorrhage: forecasting clinical outcome with artificial intelligence. Neurosurgery 88(5):e427\u2013e434","journal-title":"Neurosurgery"},{"key":"6516_CR12","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1016\/j.neures.2021.05.007","volume":"172","author":"VL DiBona","year":"2021","unstructured":"DiBona VL, Shah MK, Krause KJ, Zhu W, Voglewede MM, Smith DM, Crockett DP, Zhang H (2021) Metformin reduces neuroinflammation and improves cognitive functions after traumatic brain injury. Neurosci Res 172:99\u2013109","journal-title":"Neurosci Res"},{"key":"6516_CR13","doi-asserted-by":"publisher","first-page":"1907","DOI":"10.2147\/DDDT.S409373","volume":"17","author":"S Dutta","year":"2023","unstructured":"Dutta S, Shah RB, Singhal S, Dutta SB, Bansal S, Sinha S, Haque M (2023) Metformin: a review of potential mechanism and therapeutic utility beyond diabetes. Drug Des Devel Ther 17:1907\u20131932","journal-title":"Drug Des Devel Ther"},{"issue":"6","key":"6516_CR14","doi-asserted-by":"publisher","first-page":"1963","DOI":"10.1161\/STROKEAHA.108.544700","volume":"40","author":"JA Frontera","year":"2009","unstructured":"Frontera JA, Fernandez A, Schmidt JM, Claassen J, Wartenberg KE, Badjatia N, Connolly ES, Mayer SA (2009) Defining vasospasm after subarachnoid hemorrhage: what is the most clinically relevant definition? Stroke 40(6):1963\u20131968","journal-title":"Stroke"},{"issue":"3","key":"6516_CR15","doi-asserted-by":"publisher","first-page":"283","DOI":"10.4103\/0028-3886.98510","volume":"60","author":"S Ghosh","year":"2012","unstructured":"Ghosh S, Dey S, Maltenfort M, Vibbert M, Urtecho J, Rincon F, Jallo J (2012) Impact of Hunt-Hess grade on the glycemic status of aneurysmal subarachnoid hemorrhage patients. Neurol India 60(3):283\u2013287","journal-title":"Neurol India"},{"issue":"3","key":"6516_CR16","doi-asserted-by":"publisher","first-page":"969","DOI":"10.1097\/CCM.0b013e318198683a","volume":"37","author":"H Hallevi","year":"2009","unstructured":"Hallevi H, Dar NS, Barreto AD et al (2009) The IVH score: a novel tool for estimating intraventricular hemorrhage volume: clinical and research implications. Crit Care Med 37(3):969\u2013974","journal-title":"Crit Care Med"},{"issue":"8","key":"6516_CR17","doi-asserted-by":"publisher","first-page":"1843","DOI":"10.1161\/01.STR.31.8.1843","volume":"31","author":"GJ Hankey","year":"2000","unstructured":"Hankey GJ, Jamrozik K, Broadhurst R (2000) Epidemiology of aneurysmal subarachnoid hemorrhage in Australia and New Zealand-incidence and case fatality from the Australasian Cooperative Research on Subarachnoid Hemorrhage Study (ACROSS). Stroke 31(8):1843\u20131850","journal-title":"Stroke"},{"issue":"3","key":"6516_CR18","first-page":"515","volume":"94","author":"BB Hofmann","year":"2024","unstructured":"Hofmann BB, Fischer I, Neyazi M, Karadag C, Donaldson DM, Abusabha Y, Muhammad S, Beseoglu K, Cornelius JF, H\u00e4nggi D (2024) Revisiting the WFNS score: native computed tomography imaging improves identification of patients with \u201cfalse poor grade\u201d aneurysmal subarachnoid hemorrhage. Neurosurgery 94(3):515\u2013523","journal-title":"Neurosurgery"},{"issue":"7","key":"6516_CR19","doi-asserted-by":"publisher","first-page":"e314","DOI":"10.1161\/STR.0000000000000436","volume":"54","author":"BL Hoh","year":"2023","unstructured":"Hoh BL, Ko NU, Amin-Hanjani S et al (2023) 2023 Guideline for the management of patients with aneurysmal subarachnoid hemorrhage: a guideline from the American heart association\/American stroke association. Stroke 54(7):e314\u2013e370","journal-title":"Stroke"},{"key":"6516_CR20","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1186\/s12974-014-0177-4","volume":"11","author":"Y Liu","year":"2014","unstructured":"Liu Y, Tang G, Li Y, Wang Y, Chen X, Gu X, Zhang Z, Wang Y, Yang G-Y (2014) Metformin attenuates blood-brain barrier disruption in mice following middle cerebral artery occlusion. J Neuroinflammation 11:177","journal-title":"J Neuroinflammation"},{"issue":"19","key":"6516_CR21","doi-asserted-by":"publisher","first-page":"1494","DOI":"10.1212\/WNL.0b013e3181dd42b3","volume":"74","author":"CE Lovelock","year":"2010","unstructured":"Lovelock CE, Rinkel GJE, Rothwell PM (2010) Time trends in outcome of subarachnoid hemorrhage: population-based study and systematic review. Neurology 74(19):1494\u20131501","journal-title":"Neurology"},{"key":"6516_CR22","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1186\/1471-2407-12-517","volume":"12","author":"Q Luo","year":"2012","unstructured":"Luo Q, Hu D, Hu S, Yan M, Sun Z, Chen F (2012) In vitro and in vivo anti-tumor effect of metformin as a novel therapeutic agent in human oral squamous cell carcinoma. BMC Cancer 12:517","journal-title":"BMC Cancer"},{"key":"6516_CR23","doi-asserted-by":"publisher","first-page":"191","DOI":"10.3389\/fendo.2020.00191","volume":"11","author":"Z Lv","year":"2020","unstructured":"Lv Z, Guo Y (2020) Metformin and its benefits for various diseases. Front Endocrinol 11:191","journal-title":"Front Endocrinol"},{"issue":"11","key":"6516_CR24","doi-asserted-by":"publisher","first-page":"3015","DOI":"10.1161\/STROKEAHA.108.519942","volume":"39","author":"RL Macdonald","year":"2008","unstructured":"Macdonald RL, Kassell NF, Mayer S, Ruefenacht D, Schmiedek P, Weidauer S, Frey A, Roux S, Pasqualin A (2008) Clazosentan to overcome neurological ischemia and infarction occurring after subarachnoid hemorrhage (CONSCIOUS-1): randomized, double-blind, placebo-controlled phase 2 dose-finding trial. Stroke 39(11):3015\u20133021","journal-title":"Stroke"},{"issue":"3","key":"6516_CR25","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1007\/s12028-010-9433-3","volume":"13","author":"RL Macdonald","year":"2010","unstructured":"Macdonald RL, Higashida RT, Keller E et al (2010) Preventing vasospasm improves outcome after aneurysmal subarachnoid hemorrhage: rationale and design of CONSCIOUS-2 and CONSCIOUS-3 trials. Neurocrit Care 13(3):416\u2013424","journal-title":"Neurocrit Care"},{"issue":"7","key":"6516_CR26","doi-asserted-by":"publisher","first-page":"618","DOI":"10.1016\/S1474-4422(11)70108-9","volume":"10","author":"RL Macdonald","year":"2011","unstructured":"Macdonald RL, Higashida RT, Keller E et al (2011) Clazosentan, an endothelin receptor antagonist, in patients with aneurysmal subarachnoid haemorrhage undergoing surgical clipping: a randomised, double-blind, placebo-controlled phase 3 trial (CONSCIOUS-2). Lancet Neurol 10(7):618\u2013625","journal-title":"Lancet Neurol"},{"issue":"6","key":"6516_CR27","doi-asserted-by":"publisher","first-page":"1463","DOI":"10.1161\/STROKEAHA.111.648980","volume":"43","author":"RL Macdonald","year":"2012","unstructured":"Macdonald RL, Higashida RT, Keller E et al (2012) Randomized trial of clazosentan in patients with aneurysmal subarachnoid hemorrhage undergoing endovascular coiling. Stroke 43(6):1463\u20131469","journal-title":"Stroke"},{"issue":"12","key":"6516_CR28","doi-asserted-by":"publisher","first-page":"2614","DOI":"10.1007\/s11095-017-2199-y","volume":"34","author":"M Markowicz-Piasecka","year":"2017","unstructured":"Markowicz-Piasecka M, Sikora J, Szyd\u0142owska A, Skupie\u0144 A, Mikiciuk-Olasik E, Huttunen KM (2017) Metformin - a future therapy for neurodegenerative diseases\u202f: theme: drug discovery, development and delivery in Alzheimer\u2019s disease guest editor: Davide Brambilla. Pharm Res 34(12):2614\u20132627","journal-title":"Pharm Res"},{"issue":"3","key":"6516_CR29","doi-asserted-by":"publisher","first-page":"698","DOI":"10.3171\/2015.5.JNS142115","volume":"125","author":"TK Mukhtar","year":"2016","unstructured":"Mukhtar TK, Molyneux AJ, Hall N, Yeates DRG, Goldacre R, Sneade M, Clarke A, Goldacre MJ (2016) The falling rates of hospital admission, case fatality, and population-based mortality for subarachnoid hemorrhage in England, 1999\u20132010. J Neurosurg 125(3):698\u2013704","journal-title":"J Neurosurg"},{"issue":"7","key":"6516_CR30","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1016\/S1474-4422(09)70126-7","volume":"8","author":"DJ Nieuwkamp","year":"2009","unstructured":"Nieuwkamp DJ, Setz LE, Algra A, Linn FHH, de Rooij NK, Rinkel GJE (2009) Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: a meta-analysis. Lancet Neurol 8(7):635\u2013642","journal-title":"Lancet Neurol"},{"issue":"3","key":"6516_CR31","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1254\/jphs.SC0050160","volume":"100","author":"T Nishihashi","year":"2006","unstructured":"Nishihashi T, Trandafir CC, Wang A, Ji X, Shimizu Y, Kurahashi K (2006) Hypersensitivity to hydroxyl radicals in rat basilar artery after subarachnoid hemorrhage. J Pharmacol Sci 100(3):234\u2013236","journal-title":"J Pharmacol Sci"},{"key":"6516_CR32","doi-asserted-by":"crossref","unstructured":"Pathak A (2022) Aneurysmal SAH Induced vasospasm: pathogenesis and management. In: Lv X (ed) Endovascular Surgery of Cerebral Aneurysms. Springer Nature Singapore, Singapore, pp 9\u201327","DOI":"10.1007\/978-981-16-7102-9_2"},{"issue":"13","key":"6516_CR33","first-page":"226","volume":"114","author":"AK Petridis","year":"2017","unstructured":"Petridis AK, Kamp MA, Cornelius JF, Beez T, Beseoglu K, Turowski B, Steiger H-J (2017) Aneurysmal subarachnoid hemorrhage. Dtsch Arztebl Int 114(13):226\u2013236","journal-title":"Dtsch Arztebl Int"},{"issue":"11","key":"6516_CR34","first-page":"4988","volume":"23","author":"R-N Qu","year":"2019","unstructured":"Qu R-N, Qu W (2019) Metformin inhibits LPS-induced inflammatory response in VSMCs by regulating TLR4 and PPAR-\u03b3. Eur Rev Med Pharmacol Sci 23(11):4988\u20134995","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"6516_CR35","doi-asserted-by":"publisher","DOI":"10.3390\/ijms25053007","author":"M Salvagno","year":"2024","unstructured":"Salvagno M, Sterchele ED, Zaccarelli M, Mrakic-Sposta S, Welsby IJ, Balestra C, Taccone FS (2024) Oxidative stress and cerebral vascular tone: the role of reactive oxygen and nitrogen species. Int J Mol Sci. https:\/\/doi.org\/10.3390\/ijms25053007","journal-title":"Int J Mol Sci"},{"issue":"6","key":"6516_CR36","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.5114\/aoms.2017.68821","volume":"14","author":"R Sao","year":"2018","unstructured":"Sao R, Aronow WS (2018) Association of non-alcoholic fatty liver disease with cardiovascular disease and subclinical atherosclerosis. Arch Med Sci 14(6):1233\u20131244","journal-title":"Arch Med Sci"},{"issue":"12","key":"6516_CR37","doi-asserted-by":"publisher","first-page":"2173","DOI":"10.1007\/s00701-012-1500-4","volume":"154","author":"B Schatlo","year":"2012","unstructured":"Schatlo B, Fung C, Fathi A-R et al (2012) Introducing a nationwide registry: the Swiss study on aneurysmal subarachnoid haemorrhage (Swiss SOS). Acta Neurochir (Wien) 154(12):2173\u20138 (discussion 2178)","journal-title":"Acta Neurochir (Wien)"},{"issue":"2","key":"6516_CR38","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1161\/STROKEAHA.117.019328","volume":"49","author":"MN Stienen","year":"2018","unstructured":"Stienen MN, Germans M, Burkhardt J-K et al (2018) Predictors of in-hospital death after Aneurysmal Subarachnoid Hemorrhage: analysis of a nationwide database (Swiss SOS [Swiss Study on Aneurysmal Subarachnoid Hemorrhage]): Analysis of a nationwide database (Swiss SOS [Swiss Study on Aneurysmal Subarachnoid Hemorrhage]). Stroke 49(2):333\u2013340","journal-title":"Stroke"},{"issue":"8","key":"6516_CR39","doi-asserted-by":"publisher","first-page":"2100","DOI":"10.1161\/STROKEAHA.115.010037","volume":"46","author":"CE van Donkelaar","year":"2015","unstructured":"van Donkelaar CE, Bakker NA, Veeger NJGM, Uyttenboogaart M, Metzemaekers JDM, Luijckx G-J, Groen RJM, van Dijk JMC (2015) Predictive factors for rebleeding after aneurysmal subarachnoid hemorrhage: rebleeding aneurysmal subarachnoid hemorrhage study. Stroke 46(8):2100\u20132106","journal-title":"Stroke"},{"issue":"10","key":"6516_CR40","doi-asserted-by":"publisher","first-page":"2391","DOI":"10.1161\/STROKEAHA.110.589275","volume":"41","author":"MDI Vergouwen","year":"2010","unstructured":"Vergouwen MDI, Vermeulen M, van Gijn J et al (2010) Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies: proposal of a multidisciplinary research group. Stroke 41(10):2391\u20132395","journal-title":"Stroke"},{"issue":"1","key":"6516_CR41","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1212\/WNL.0000000000002239","volume":"86","author":"MDI Vergouwen","year":"2016","unstructured":"Vergouwen MDI, Jong-Tjien-Fa AV, Algra A, Rinkel GJE (2016) Time trends in causes of death after aneurysmal subarachnoid hemorrhage: A hospital-based study. Neurology 86(1):59\u201363","journal-title":"Neurology"},{"issue":"1","key":"6516_CR42","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/cpf.12787","volume":"43","author":"D Viderman","year":"2023","unstructured":"Viderman D, Tapinova K, Abdildin YG (2023) Mechanisms of cerebral vasospasm and cerebral ischaemia in subarachnoid haemorrhage. Clin Physiol Funct Imaging 43(1):1\u20139","journal-title":"Clin Physiol Funct Imaging"},{"issue":"9596","key":"6516_CR43","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","volume":"370","author":"E von Elm","year":"2007","unstructured":"von Elm E, Altman DG, Egger M, Pocock SJ, G\u00f8tzsche PC, Vandenbroucke JP, Initiative STROBE (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370(9596):1453\u20131457","journal-title":"Lancet"},{"key":"6516_CR44","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1016\/j.jns.2016.10.020","volume":"371","author":"B Zhao","year":"2016","unstructured":"Zhao B, Fan Y, Xiong Y, Yin R, Zheng K, Li Z, Tan X, Yang H, Zhong M, AMPAS Study Group (2016) Aneurysm rebleeding after poor-grade aneurysmal subarachnoid hemorrhage: Predictors and impact on clinical outcomes. J Neurol Sci 371:62\u201366","journal-title":"J Neurol Sci"},{"issue":"9","key":"6516_CR45","doi-asserted-by":"publisher","first-page":"16619","DOI":"10.1002\/jcp.28337","volume":"234","author":"X Zhao","year":"2019","unstructured":"Zhao X, Zeng Z, Gaur U, Fang J, Peng T, Li S, Zheng W (2019) Metformin protects PC12 cells and hippocampal neurons from H2 O 2 -induced oxidative damage through activation of AMPK pathway. J Cell Physiol 234(9):16619\u201316629","journal-title":"J Cell Physiol"},{"key":"6516_CR46","doi-asserted-by":"publisher","first-page":"1373925","DOI":"10.3389\/fphys.2024.1373925","volume":"15","author":"D Zhao","year":"2024","unstructured":"Zhao D, Li Y, Cui J (2024) The factors associated with the modified Fisher grade in patients with aneurysmal subarachnoid hemorrhage. Front Physiol 15:1373925","journal-title":"Front Physiol"}],"container-title":["Acta Neurochirurgica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-025-06516-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00701-025-06516-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-025-06516-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,10]],"date-time":"2025-04-10T09:42:55Z","timestamp":1744278175000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00701-025-06516-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,10]]},"references-count":46,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["6516"],"URL":"https:\/\/doi.org\/10.1007\/s00701-025-06516-5","relation":{},"ISSN":["0942-0940"],"issn-type":[{"value":"0942-0940","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,10]]},"assertion":[{"value":"20 September 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 April 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 April 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not Applicable. Written informed consent for included patients was waived by the local University of Texas Health Science Center at Houston\/Memorial Hermann Healthcare System IRB in view of the study\u2019s retrospective design and no more than a minimal risk to individual\u2019s privacy.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable. This research study was conducted retrospectively from data obtained for clinical purposes. We consulted extensively with the IRB who determined that our study did not need ethical approval. An IRB official waiver of ethical approval was granted from the IRB.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human ethics and consent to participate declarations"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"103"}}