Decompressive Surgery in Patients with Poor-grade Aneurysmal Subarachnoid Hemorrhage: Clipping with Simultaneous Decompression Versus Coil Embolization Followed by Decompression
Journal of Cerebrovascular and Endovascular Neurosurgery
;
: 254-261, 2014.
Article
in English
| WPRIM
| ID: wpr-193372
ABSTRACT
OBJECTIVE:
In addition to obliterating the aneurysm using clipping or coiling, decompressive surgery for control of rising intracranial pressure (ICP) is thought to be crucial to prevention of adverse outcomes in patients with poor grade aneurysmal subarachnoid hemorrhage (aSAH). We evaluated the clinical characteristics of patients with poor-grade aSAH, and compared outcomes of aneurysmal clipping with simultaneous decompressive surgery to those of coil embolization followed by decompression. MATERIALS ANDMETHODS:
In 591 patients with aSAH, 70 patients with H-H grade IV and V underwent decompressive surgery including craniectomy, lobectomy, and hematoma removal. We divided the patients into two groups according to clipping vs. coil embolization (clip group vs. coil group), and analyzed outcomes and mortality.RESULTS:
Aneurysmal clipping was performed in 40 patients and coil embolization was performed in 30 patients. No significant differences in demographics were observed between the two groups. Middle cerebral artery and posterior circulation aneurysms were more frequent in the clip group. Among 70 patients, mortality occurred in 29 patients (41.4%) and 61 patients (87.1%) had a poor score on the Glasgow outcome scale (scores I-III). No significant difference in mortality was observed between the two groups, but a favorable outcome was more frequent in the coil group (p < 0.05).CONCLUSION:
In this study, despite aggressive surgical and endovascular management for elevated ICP, there were high rates of adverse outcomes and mortality in poor-grade aSAH. Despite poor outcomes overall, early coil embolization followed by decompression surgery could lead to more favorable outcomes in patients with poor-grade aSAH.
Full text:
Available
Index:
WPRIM (Western Pacific)
Main subject:
Subarachnoid Hemorrhage
/
Intracranial Pressure
/
Intracranial Aneurysm
/
Demography
/
Mortality
/
Intracranial Hypertension
/
Middle Cerebral Artery
/
Glasgow Outcome Scale
/
Decompression
/
Embolization, Therapeutic
Type of study:
Prognostic study
Limits:
Humans
Language:
English
Journal:
Journal of Cerebrovascular and Endovascular Neurosurgery
Year:
2014
Type:
Article
Similar
MEDLINE
...
LILACS
LIS