Determination of indications for early surgical treatment in patients with ruptured anterior communicating artery aneurysms
DOI:
https://doi.org/10.14739/2310-1210.2023.3.276000Keywords:
AcomA aneurysm, brain swelling, intracerebral hematoma, microsurgical treatmentAbstract
Aim. To analyze and determine the optimal indications for microsurgical operative interventions in the shortest possible time from the subarachnoid hemorrhage onset to prevent anterior communicating artery (AcomA) aneurysm re-rupture and bleeding.
Materials and methods. 280 patients with brain aneurysms were examined at the Uzhhorod Regional Center of Neurosurgery and Neurology and the City Hospital of Urgent and Emergency Medical Care under Zaporizhzhia City Council. Among them, 98 patients (48 males and 50 females) were diagnosed with AcomA aneurysms. The age of patients with AcomA aneurysms was from 20 to 72 years (mean age 47.8 ± 11.0 years). Aneurysms were verified using head and neck computed tomography angiography (a Toshiba Astelion scanner, 2016, No. 4СС162106), selective cerebral angiography (an angiography system General Energy Optima IGS 330, 2019, No. 80071260314), and brain magnetic resonance angiography (an i_Open 0,36 T magnetic resonance tomograph, 2005, No. Toc102633006). Cerebral hemodynamics was assessed using transcranial dopplerography (“Philips HD7” ultrasound diagnostic system, 2014, No. 69935).
Results. In the first three days after the onset of subarachnoid hemorrhage, 18 (18 %) patients were admitted with ruptured aneurysms of this location, 62 (62 %) within 4–8 days, 12 (12 %) patients within 9–14 days, later than 14 days – 6 (6 %). All 98 patients underwent microsurgical clipping of AcomA aneurysms. Due to severe cerebral edema, decompressive craniectomy was performed in two patients. The results of surgical treatment were evaluated according to the modified Rankin scale at the time of hospital discharge and were as follows: in 65 (65 %) patients – good; in 18 (18 %) – moderate disability; in 4 (4 %) – serious disability. 11 (11 %) patients died.
Conclusions. The treatment outcomes in patients with ruptured AcomA aneurysms were significantly dependent on factors related to increased risk of re-rupture: the presence of large-sized intracerebral hematoma, the aneurysm index exceeding 2, and multi-chamber aneurysm.
References
Greenberg, M. S. (2019). Handbook of Neurosurgery. Thieme Medical Publishers Inc.
Świątnicki, W., Radomiak-Załuska, A., Heleniak, M., & Komuński, P. (2019). Factors determining the best surgical exposure and safe clip positioning in surgical treatment of anterior communicating artery (AComA) aneurysms - particular significance of AComA complex rotation in the axial plane. Polski przeglad chirurgiczny, 91(6), 6-10. https://doi.org/10.5604/01.3001.0013.5285
Ronkainen, A., Miettinen, H., Karkola, K., Papinaho, S., Vanninen, R., Puranen, M., & Hernesniemi, J. (1998). Risk of harboring an unruptured intracranial aneurysm. Stroke, 29(2), 359-362. https://doi.org/10.1161/01.str.29.2.359
Fisher, C. M., Kistler, J. P., & Davis, J. M. (1980). Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery, 6(1), 1-9. https://doi.org/10.1227/00006123-198001000-00001
Jennett, B., & Bond, M. (1975). Assessment of outcome after severe brain damage. Lancet, 1(7905), 480-484. https://doi.org/10.1016/s0140-6736(75)92830-5
Cai, W., Hu, C., Gong, J., & Lan, Q. (2018). Anterior Communicating Artery Aneurysm Morphology and the Risk of Rupture. World neurosurgery, 109, 119-126. https://doi.org/10.1016/j.wneu.2017.09.118
Brown, M. A., Parish, J., Guandique, C. F., Payner, T. D., Horner, T., Leipzig, T., Rupani, K. V., Kim, R., Bohnstedt, B. N., & Cohen-Gadol, A. A. (2017). A long-term study of durability and risk factors for aneurysm recurrence after microsurgical clip ligation. Journal of neurosurgery, 126(3), 819-824. https://doi.org/10.3171/2016.2.JNS152059
Chen, Y., Xing, H., Lin, B., Zhou, J., Ding, S., Wan, J., Yang, Y., Pan, Y., & Zhao, B. (2020). Morphological risk model assessing anterior communicating artery aneurysm rupture: Development and validation. Clinical neurology and neurosurgery, 197, 106158. https://doi.org/10.1016/j.clineuro.2020.106158
Chen, J., Li, M., Zhu, X., Chen, Y., Zhang, C., Shi, W., Chen, Q., & Wang, Y. (2020). Anterior Communicating Artery Aneurysms: Anatomical Considerations and Microsurgical Strategies. Frontiers in neurology, 11, 1020. https://doi.org/10.3389/fneur.2020.01020
Detmer, F. J., Chung, B. J., Jimenez, C., Hamzei-Sichani, F., Kallmes, D., Putman, C., & Cebral, J. R. (2019). Associations of hemodynamics, morphology, and patient characteristics with aneurysm rupture stratified by aneurysm location. Neuroradiology, 61(3), 275-284. https://doi.org/10.1007/s00234-018-2135-9
Goertz, L., Hamisch, C., Telentschak, S., Kabbasch, C., von Spreckelsen, N., Stavrinou, P., Timmer, M., Goldbrunner, R., Brinker, G., & Krischek, B. (2018). Impact of Aneurysm Shape on Intraoperative Rupture During Clipping of Ruptured Intracranial Aneurysms. World neurosurgery, 118, e806-e812. https://doi.org/10.1016/j.wneu.2018.07.058
Ito, Y., Yamamoto, T., Ikeda, G., Tsuruta, W., Uemura, K., Komatsu, Y., & Matsumura, A. (2017). Early retreatment after surgical clipping of ruptured intracranial aneurysms. Acta neurochirurgica, 159(9), 1627-1632. https://doi.org/10.1007/s00701-017-3245-6
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