ABSTRACT
INTRODUCTION: The subarachnoid hemorrhage (SAH) is excess presence of blood in the subarachnoid space. The most frequent cause of SAH is cerebral aneurysm rupture and neurotrauma. The treatment strategy is specific for the different forms of SAH but all therapeutic options are based on the prevention of secondary ischemic brain injury generating after initial hemorrhage. OBJECTIVE: To point out the varieties of SAH etiology and different modalities of its treatment, especially presenting the aneurismal SAH. PATIENTS, METHODS AND RESULTS: The retrospective-prospective study was performed at the Department of Neurosurgery in Sarajevo (DNS). Over a span of two years, from January 1st 2003 to December 31st 2004, 161 patients with etiologically different SAH were treated. The higher number of patients was treated during 2004 compared with a year before, respectively 101 and 60 patients. Totally, eighty three patients were operated on (52%, 83/161). The surgery was performed in 60% (61/101) of cases in the second year but only 37% in the first year of study (22/60). The most frequent cause of SAH was the rupture of cerebral aneurysm (48%). The other causes were trauma (28%), brain arteriovenous malformations (4, 3%) and hypertension with atherosclerosis (1.8%). The cause is not found in 18% of cases (29/161) and this SAH category is defined as an idiopathic SAH. A total of 64 patients with ruptured aneurysms were operated on by the author (KD) during two years 17 in 2003, and 47 in 2004. DISCUSSION: We use the defined treatment protocols for the different forms of SAH which are based on current knowledge and particulars of locality aiming to decreased possibilities of repeated bleeding and delayed ischemia. The higher number of patients with aneurysmal SAH compared to those with traumatic SAH was admitted. The reason for this is the fact that systematic management of patients with cerebral aneurysms in Bosnia and Herzegovina has been doing exclusively in our Department. CONCLUSION: The number of treated patients with SAH, especially aneurismal SAH, is significantly increased in DNS during two last years. Our patients received the standard and current treatment which implies micro neurosurgery and conservative care at the separate Neurosurgical intensive care unit. The introduction of endovascular neurosurgery and developing of neuroanesthesia as a subdiscipline is expected to increase the quality of our serves.
