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Published on: August 11, 2015
Decompressive Surgery in Patients with Poor-grade Aneurysmal Subarachnoid Hemorrhage: Clipping with Simultaneous
Ui Seung Hwang1, Hee Sup Shin1, Seung Hwan Lee1
1Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.
Insights
For poor-grade aneurysmal subarachnoid hemorrhage (aSAH), decompressive surgery is vital. Early coil embolization combined with decompression surgery may offer better outcomes than clipping, despite high overall mortality.
Area of Science:
- Neurosurgery
- Endovascular Surgery
- Critical Care Neurology
Background:
- Poor-grade aneurysmal subarachnoid hemorrhage (aSAH) presents significant challenges.
- Elevated intracranial pressure (ICP) is a critical factor in poor outcomes.
- Decompressive surgery is considered essential for managing elevated ICP in aSAH.
Purpose of the Study:
- To evaluate clinical characteristics of poor-grade aSAH patients.
- To compare outcomes of aneurysmal clipping with simultaneous decompressive surgery versus coil embolization followed by decompression.
Main Methods:
- Retrospective analysis of 70 patients with Hunt-Hess grade IV-V aSAH.
- Patients underwent decompressive surgery (craniectomy, lobectomy, hematoma removal).
- Comparison between aneurysmal clipping (n=40) and coil embolization (n=30) groups.
Main Results:
- Overall mortality was 41.4%; 87.1% had poor Glasgow Outcome Scale scores.
- No significant difference in mortality between clipping and coiling groups.
- Favorable outcomes were more frequent in the coil embolization group (p < 0.05).
Conclusions:
- High rates of mortality and adverse outcomes persist in poor-grade aSAH despite aggressive management.
- Early coil embolization followed by decompressive surgery may improve outcomes.
- Further research is needed to optimize treatment strategies for severe aSAH.
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 And Methods:
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.
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