Surgical treatment of complicated aneurysmаl SAH. An analysis of treatment results when using endovascular coiling or microsurgical clipping of aneurysm
DOI:
https://doi.org/10.14739/2310-1210.2020.5.214722Keywords:
subarachnoid hemorrhage, endovascular coiling, microsurgeryAbstract
Aim – to compare the treatment results of the acute period of aneurysmal subarachnoid hemorrhage (SAH) with a complicated course depending on the method used for occlusion of the aneurysm - microsurgical clipping or endovascular coiling.
Material and methods. The treatment results of patients with aneurysmal SAH were analyzed, among which 124 cases (49.6 %) with the complicated course were identified and divided into a “coiling” group and a “clipping” group. The severity of SAH was determined using the Hunt-Hess and WFNS clinical scales, and the Fisher radiological scale. The result was evaluated according to the modified Rankin scale (mRS).
Results. Age gradation and gender differences in the compared groups did not have a significant difference. An almost equal number of aneurysms of the anterior cerebral - anterior communicating artery complex was noted, 54.84 % in the “coiling” group and 61.29 % in the “clipping” group. The “coiling” group was dominated by internal carotid artery aneurysms (32.26 %), while middle cerebral artery aneurysms prevailed in the “clipping” group (35.48 %). There were no significant differences in the severity of SAH (mean value (mv)): WFNS in the “coiling” group – 2.1 and Hunt–Hess – 2.63, in the “clipping” group – 2.1 and 2.7, respectively; the mv on the Fisher scale was3.5 in the “coiling” and 3.4 – in the “clipping” group. The mv of the dysfunction degree according to mRS amounted to2.64 in the “coiling” group and3.5 in the “clipping” group. A good treatment result (mRS score of 1–2) was noted in 67.7 % of cases in the “coiling” group, while in the “clipping” group – in 37.1 %. Mortality rate was 17.7 % in the “coiling” group and 19.3 % – in the “clipping” group. There was a direct correlation between the SAH severity according to the Hunt–Hess and WFNS scales and mRS. There was no correlation between the SAH severity according to the Fisher scale and mRS.
Conclusions. With the same severity of complicated aneurysmal SAH according to the generally accepted scales, the functional treatment outcome was better in the “coiling” group. The Fisher scale did not correlate with the functional outcome defined by mRS. Microsurgical “clipping” often resulted in the development of shunt-dependent hydrocephalus.
References
Huang, J., & van Gelder, J. M. (2002). The probability of sudden death from rupture of intracranial aneurysms: a meta-analysis. Neurosurgery, 51(5), 1101-1107. https://doi.org/10.1097/00006123-200211000-00001
de Rooij, N. K., Linn, F. H., van der Plas, J. A., Algra, A., & Rinkel, G. J. (2007). Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trends. Journal of Neurology, Neurosurgery & Psychiatry, 78(12), 1365-1372. https://doi.org/10.1136/jnnp.2007.117655
Nieuwkamp, D. J., Setz, L. E., Algra, A., Linn, F. H., de Rooij, N. K., & Rinkel, G. J. (2009). Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: a meta-analysis. The Lancet. Neurology, 8(7), 635-642. https://doi.org/10.1016/S1474-4422(09)70126-7
Vergouwen, M. D., Jong-Tjien-Fa, A. V., Algra, A., & Rinkel, G. J. (2016). Time trends in causes of death after aneurysmal subarachnoid hemorrhage: A hospital-based study. Neurology, 86(1), 59-63. https://doi.org/10.1212/WNL.0000000000002239
Sonig, A., Shallwani, H., Natarajan, S. K., Shakir, H. J., Hopkins, L. N., Snyder, K. V., Siddiqui, A. H., & Levy, E. I. (2017). Better Outcomes and Reduced Hospitalization Cost are Associated with Ultra-Early Treatment of Ruptured Intracranial Aneurysms: A US Nationwide Data Sample Study. Neurosurgery, 82(4), 497-505. https://doi.org/10.1093/neuros/nyx241
Luo, Y. C., Shen, C. S., Mao, J. L., Liang, C. Y., Zhang, Q., & He, Z. J. (2015). Ultra-early versus delayed coil treatment for ruptured poor-grade aneurysm. Neuroradiology, 57(2), 205-210. https://doi.org/10.1007/s00234-014-1454-8
Frontera, J. A., Fernandez, A., Schmidt, J. M., Claassen, J., Wartenberg, K. E., Badjatia, N., Connolly, E. S., & Mayer, S. A. (2009). Defining Vasospasm After Subarachnoid Hemorrhage: What Is the Most Clinically Relevant Definition? Stroke, 40(6), 1963-1968. https://doi.org/10.1161/STROKEAHA.108.544700
Shirao, S., Yoneda, H., Ishihara, H., Kajiwara, K., Suzuki, M., & Survey Study Members of Japan Neurosurgical Society. (2011). A proposed definition of symptomatic vasospasm based on treatment of cerebral vasospasm after subarachnoid hemorrhage in Japan: Consensus 2009, a project of the 25th Spasm Symposium. Surgical Neurology International, 2, Article 74. https://doi.org/10.4103/2152-7806.81968
Molyneux, A. J., Kerr, R. S., Yu, L. M., Clarke, M., Sneade, M., Yarnold, J. A., Sandercock, P., & International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. (2005). International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. The Lancet, 366(9488), 809-817. https://doi.org/10.1016/S0140-6736(05)67214-5
Darsaut, T. E., Jack, A. S., Kerr, R. S., & Raymond, J. (2013). International subarachnoid aneurysm trial – ISAT Part II: Study protocol for a randomized controlled trial. Trials, 14, Article 156. https://doi.org/10.1186/1745-6215-14-156
Spetzler, R. F., McDougall, C. G., Zabramski, J. M., Albuquerque, F. C., Hills, N. K., Nakaji, P., Karis, J. P., & Wallace, R. C. (2019). Ten-year analysis of saccular aneurysms in the Barrow Ruptured Aneurysm Trial. Journal of Neurosurgery, 132, 771-776. https://doi.org/10.3171/2018.8.JNS181846
Li, H., Pan, R., Wang, H., Rong, X., Yin, Z., Milgrom, D. P., Shi, X., Tang, Y., & Peng, Y. (2013). Clipping versus coiling for ruptured intracranial aneurysms: a systematic review and meta-analysis. Stroke, 44(1), 29-37. https://doi.org/10.1161/STROKEAHA.112.663559
Wang, H. Y., Song, J., Gao, F., Duan, X. D., Gao, X., Wang, Y., Cheng, H. B., Nan, C. R., & Zhao, D. (2019). Outcomes of microsurgical clipping vs coil embolization for ruptured aneurysmal subarachnoid hemorrhage: A multicenter real-world analysis of 583 patients in China. Medicine, 98(33), Article e16821. https://doi.org/10.1097/MD.0000000000016821
de Oliveira Manoel, A. L., Goffi, A., Marotta, T. R., Schweizer, T. A., Abrahamson, S., & Macdonald, R. L. (2016). The critical care management of poor-grade subarachnoid haemorrhage. Critical Care, 20, Article 21. https://doi.org/10.1186/s13054-016-1193-9
Al-Mufti, F., Misiolek, K. A., Roh, D., Alawi, A., Bauerschmidt, A., Park, S., Agarwal, S., Meyers, P. M., Connolly, E. S., Claassen, J., & Schmidt, J. M. (2019). White Blood Cell Count Improves Prediction of Delayed Cerebral Ischemia Following Aneurysmal Subarachnoid Hemorrhage. Neurosurgery, 84(2), 397-403. https://doi.org/10.1093/neuros/nyy045
Murphy, A., Lee, T. Y., Marotta, T. R., Spears, J., Macdonald, R. L., Aviv, R. I., Baker, A., & Bharatha, A. (2018). Prospective Multicenter Study of Changes in MTT after Aneurysmal SAH and Relationship to Delayed Cerebral Ischemia in Patients with Good- and Poor-Grade Admission Status. American Journal of Neuroradiology, 39(11), 2027-2033. https://doi.org/10.3174/ajnr.A5844
Netlyukh, А. М. (2016). Biokhimichni markery uskladnenoho perebihu anevryzmatychnoho subarakhnoidalnoho krovovylyvu v syrovattsi krovi ta likvori khvorykh [Biochemical markers of the complicated course of aneurysmal subarachnoid hemorrhage in patients’ blood serum and cerebrospinal fluid]. Endovaskuliarna neirorenthenokhirurhiia, (4), 40-47. [in Ukrainian].
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