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Double Direct Injection of Blood into the Cisterna Magna as a Model of Subarachnoid Hemorrhage
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Double Direct Injection of Blood into the Cisterna Magna as a Model of Subarachnoid Hemorrhage

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Strategies in management of ruptured aneurysms--own experiences with various therapeutical procedures in severe SAH

A Gräwe1, U Meier, H P Molsen

  • 1Department of Neurosurgery, Unfallkrankenhaus Berlin. AlexanderG@ukb.de

Neurologia I Neurochirurgia Polska
|July 17, 2001
PubMed

Insights

This study on spontaneous subarachnoid hemorrhage (SAH) found that while treatments like clipping and coilembolization can be effective, severe cases often lead to poor outcomes. Prompt intervention is crucial for improving survival rates in SAH patients.

Area of Science:

  • Neurosurgery
  • Neurology
  • Critical Care Medicine

Background:

  • Spontaneous subarachnoid hemorrhage (SAH) is a critical neurological emergency.
  • Severe SAH (Hunt and Hess grades IV-V) carries a high mortality and morbidity rate.
  • Optimal management strategies for complex SAH cases remain an area of active research.

Purpose of the Study:

  • To retrospectively analyze treatment outcomes for patients with spontaneous SAH.
  • To evaluate the effectiveness of different neurosurgical and endovascular interventions.
  • To assess the impact of associated hemorrhages and necessary surgical procedures on patient outcomes.

Main Methods:

  • Retrospective analysis of 58 patients diagnosed with spontaneous SAH.
  • Categorization of patients based on SAH severity (Hunt and Hess grades IV-V).
  • Review of treatment modalities including surgical clipping, endovascular coilembolization, hematoma evacuation, and ventricular drainage.

Main Results:

  • Of 33 severe SAH patients, 11 died without treatment.
  • 22 patients received treatment: 16 underwent clipping, 6 endovascular coilembolization.
  • 14 SAH cases were associated with other hemorrhages, often requiring initial hematoma evacuation or ventricular drainage; 4 combined with aneurysm clipping.
  • Post-treatment, 4 patients died (GOS1), 12 were severely disabled (GOS3), and 6 moderately disabled (GOS4).

Conclusions:

  • Treatment for spontaneous SAH, particularly severe cases, is associated with significant disability and mortality.
  • Complex SAH involving associated hemorrhages necessitates multi-stage interventions, impacting outcomes.
  • While interventions like clipping and coilembolization are utilized, achieving favorable outcomes in severe SAH remains challenging.

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