[Surgical treatment of intracranial aneurysms in acute period of hemorrhage in Hunt-Hess grade IV-V patients at Burdenko Neurosurgical Center between 2006 and 2020].

Autor: Eliava SS; Burdenko Neurosurgical Center, Moscow, Russia., Pilipenko YV; Burdenko Neurosurgical Center, Moscow, Russia., Belousova OB; Burdenko Neurosurgical Center, Moscow, Russia., Gvazava GI; Burdenko Neurosurgical Center, Moscow, Russia., Grebenev FV; Burdenko Neurosurgical Center, Moscow, Russia., Konovalov AN; Burdenko Neurosurgical Center, Moscow, Russia., Mikeladze KG; Burdenko Neurosurgical Center, Moscow, Russia., Varyukhina MD; Federal Research Clinical Center of Intensive Care and Rehabilitology, Moscow, Russia.
Jazyk: English; Russian
Zdroj: Zhurnal voprosy neirokhirurgii imeni N. N. Burdenko [Zh Vopr Neirokhir Im N N Burdenko] 2023; Vol. 87 (6), pp. 5-13.
DOI: 10.17116/neiro2023870615
Abstrakt: Background: Management of patients in acute period of aneurysmal subarachnoid hemorrhage Hunt - Hess grade IV-V is still a complex and unsolved problem, especially regarding surgical treatment and various complications.
Objective: To analyze postoperative outcomes in patients undergoing surgery in acute period of aneurysmal subarachnoid hemorrhage Hunt - Hess grade IV-V between 2006 and 2020, as well as to assess various factors influencing treatment outcomes.
Material and Methods: We analyzed 163 patients who underwent surgery within 21 days after aneurysmal subarachnoid hemorrhage Hunt - Hess grade IV-V. All patients were divided into 2 groups depending on the period: 2006-2011 (group 1) and 2012-2020 (group 2).
Results: Mortality reduced from 28.6% in group 1 to 8.3% in group 2. At the same time, incidence of vegetative state (GOS grade 2) increased from 4.8% to 17.4%. Incidence of outcomes GOS grade 3 - 5 was similar.
Conclusion: Large or giant aneurysm, repeated preoperative subarachnoid hemorrhage, intraoperative aneurysm rupture and prolonged temporary clipping can impair postoperative outcomes in patients with hemorrhage Hunt - Hess grade IV-V. External ventricular drainage, intraarterial injection of verapamil, intracisternal administration of calcium channel blockers and active surgical tactics improve postoperative outcomes and reduce mortality.
Databáze: MEDLINE
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