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An analysis of vasospasm following early surgery for intracranial aneurysms
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Early surgery for ruptured intracranial aneurysms may not worsen outcomes from vasospasm. While vasospasm significantly impacts outcomes, early intervention appears to mitigate neurological deterioration compared to delayed surgery.
Area of Science:
- Neurosurgery
- Neurology
- Radiology
Background:
- Subarachnoid hemorrhage (SAH) from ruptured intracranial aneurysms carries significant risks, including vasospasm.
- Vasospasm is a major cause of morbidity and mortality following SAH.
- Intracisternal blood on CT scans is a key risk factor for developing vasospasm.
Purpose of the Study:
- To evaluate the impact of early surgical intervention (within 3 days) on outcomes in patients with ruptured intracranial aneurysms.
- To compare the incidence of vasospasm and subsequent neurological deterioration between early surgery and delayed surgery groups.
- To determine if early surgery alters the influence of vasospasm on patient outcomes.
Main Methods:
- Retrospective analysis of 41 patients undergoing early surgery for ruptured aneurysms.
- Comparison of early surgery group with a cohort of 76 patients who had delayed surgery (≥10 days).
- Evaluation of CT scan findings, particularly intracisternal blood, as a predictor of vasospasm.
Main Results:
- Vasospasm was a significant factor in morbidity (58%) and mortality (64%) in the early surgery group.
- The incidence of vasospasm was similar between early and delayed surgery groups.
- Neurological deterioration due to vasospasm was higher in the delayed surgery group (55%) compared to the early surgery group (36%).
Conclusions:
- Early surgical intervention for ruptured intracranial aneurysms does not appear to exacerbate the negative impact of vasospasm.
- Despite early surgery, clinical deterioration from vasospasm can still occur.
- The study suggests vasospasm's influence on outcomes may be comparable to its effect during the natural course of SAH, even with early intervention.
Abstract:
41 patients with ruptured intracranial aneurysms were all submitted to an early operation, (within 3 days from SAH), and evaluated with regard to the results of treatment. In this group, vasospasm has influenced the outcome more than other causes, accounting for 58% of morbidity and 64% of mortality. On the basis of our experience with 380 patients suffering from SAH and all submitted to a CT scan, the presence of consistent intracisternal blood in the CT scan at admission has shown to be the main risk factor resulting in vasospasm. Therefore, the group with early surgery has been compared, on the basis of the CT scan picture, to a group of 76 patients in which surgery had been delayed at least 10 days after SAH. Whilst the incidence of vasospasm has been very similar in the groups compared, the incidence of neurological deterioration brought about by spasm has been higher in patients waiting for surgery (55%, against 36% in the group with early surgery). Avoidance of clinical deterioration has not been always possible with early surgery, even after careful cleansing of the cisterns from clots, as was shown by 2 of our cases. It is concluded that vasospasm does not seem to influence the outcome of early surgery to a greater extent than it would during the natural course of subarachnoid haemorrhage.