Timing of Surgery for Aneurysmal Subarachnoid Hemorrhage
Abstract
Despite the many studies about timing for surgery in subarachnoid hemorrhage (SAH), the optimum time is still unclear. The aim of this study was to determine the results of early and late surgery for aneurysmal subarachnoid hemorrhage. In this cross-sectional study we evaluated the results of 70 consecutive surgery for aneurysmal subarachnoid hemorrhage in in Firuzgar hospital from 2005 to 2008. Surgery was performed in 50 cases (71.4%) in early period after SAH (first 4 days) and in 20 cases (28.6%) in at least 7 days after SAH. Statitical analysis was done by SPSS software, using Chi-square and t-test. Mean age of patients was 48.54 ± 13.4 years. 41.4% of patients were male and 58.6% were female. Most (77.2%) of patients had clinical grade I or II. 92.9% of aneurysms were single. Hypertension was the most common associated disease (34.3%). The most common site of aneurysms was anterior communicating artery (41.4%), followed by middle cerebral artery (35.7%). The outcome of surgery was favorable in 70% and unfavorable in 30%. Mortality rate was 24.3%. Outcome was favorable in 66% of early surgeries and 80% of late surgeries. There was no statistically significant difference between early and late surgery in terms of complications and outcome. Mean hospital stay of patients in the early surgery group was significantly lower than late group (16.46 ± 9.36 vs. 22.5 ± 7.97 days; P=0.01). The results of early and late surgery for aneurysmal subarachnoid hemorrhage is similar and decision making for timing of surgery should be based on each patient individual clinical conditions, age, size and site of aneurysm.
Ross N, Hutchinson PJ, Seeley H, Kirkpatrick PJ. Timing of surgery for supratentorial aneurysmal subarachnoid haemorrhage: report of a prospective study. J Neurol Neurosurg Psychiatry 2002;72(4):480-4.
Kassell NF, Torner JC, Haley EC Jr, Jane JA, Adams HP, Kongable GL. The International Cooperative Study on the Timing of Aneurysm Surgery. Part 1: Overall management results. J Neurosurg 1990;73(1):18-36.
Maurice-Williams RS, Wadley JP. Delayed surgery for ruptured intracranial aneurysms: a reappraisal. Br J Neurosurg 1997;11(2):104-9.
Ohman J, Heiskanen O. Timing of operation for ruptured supratentorial aneurysms: a prospective randomized study. J Neurosurg 1989;70(1):55-60.
Solomon RA, Fink ME, Lennihan L. Early aneurysm surgery and prophylactic hypervolemic hypertensive therapy for the treatment of aneurysmal subarachnoid hemorrhage. Neurosurgery 1988;23(6):699-704.
Kassell NF, Torner JC, Jane JA, Haley EC Jr, Adams HP. The International Cooperative Study on the Timing of Aneurysm Surgery. Part 2: Surgical results. J Neurosurg. 1990;73(1):37-47.
Kassell NF, Boarini DJ, Adams HP Jr, Sahs AL, Graf CJ, Torner JC, Gerk MK. Overall management of ruptured aneurysm: comparison of early and late operation. Neurosurgery 1981;9(2):120-8.
Nieuwkamp DJ, de Gans K, Algra A, Albrecht KW,Boomstra S, Brouwers PJ, Groen RJ, Metzemaekers JD, Nijssen PC, Roos YB, Tulleken CA, Vandertop WP, van Gijn J, Vos PE, Rinkel GJ. Timing of aneurysm surgery in subarachnoid haemorrhage--an observational study in The Netherlands. Acta Neurochir (Wien) 2005;147(8):815-21.
Miyaoka M, Sato K, Ishii S. A clinical study of the relationship of timing to outcome of surgery for ruptured cerebral aneurysms. A retrospective analysis of 1622 cases. J Neurosurg 1993;79(3):373-8.
Adams HP Jr, Kassell NF, Kongable GA, Torner JC. Intracranial operation within seven days of aneurysmal subarachnoid hemorrhage. Results in 150 patients. Arch Neurol 1988;45(10):1065-9.
Samson DS, Hodosh RM, Reid WR, Beyer CW, Clark WK. Risk of intracranial aneurysm surgery in the good grade patient: early versus late operation. Neurosurgery 1979;5(4):422-6.
Dizdarević K, Iblizović N, Kadić N. arly and urgent (micro)surgery of single and multiple intracranialaneurysms of anterior and posterior circulation and total mortality rate after operative and conservative treatment. Med Arh 2004;58(5):301-5.
Solenski NJ, Haley EC Jr, Kassell NF, Kongable G, Germanson T, Truskowski L, Torner JC. Medical complications of aneurysmal subarachnoid hemorrhage: a report of the multicenter, cooperative aneurysm study. Participants of the Multicenter Cooperative Aneurysm Study. Crit Care Med 1995;23(6):1007-17.
Bolander HG, Kourtopoulos H, West KA. Retrospective analysis of 162 consecutive cases of ruptured intracranial aneurysms. Total mortality and early surgery. Acta Neurochir (Wien) 1984;70(1-2):31-41.
Leipzig TJ, Redelman K, Horner TG. Reducing the risk of rebleeding before early aneurysm surgery: a possible role for antifibrinolytic therapy. J Neurosurg 1997;86(2):220-5.
Teasdale GM, Drake CG, Hunt W, Kassell N, Sano K, Pertuiset B, De Villiers JC. A universal subarachnoid hemorrhage scale: report of a committee of the World Federation of Neurosurgical Societies. J Neurol Neurosurg Psychiatry 1988;51(11):1457.
Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet 1975;1(7905):480-4.
le Roux AA, Wallace MC. Outcome and cost of aneurysmal subarachnoid hemorrhage. Neurosurg Clin N Am 2010;21(2):235-46.
Lee JM, Kim TS, Joo SP, Yoon W, Choi HY. Endovascular treatment of ruptured dissecting vertebral artery aneurysms--long-term follow-up results, benefits of early embolization, and predictors of outcome. Acta Neurochir (Wien) 2010;152(9):1455-65.
Taylor CJ, Robertson F, Brealey D, O'shea F, Stephen T, Brew S, Grieve JP, Smith M, Appleby I. Outcome in poor grade subarachnoid hemorrhage patients treated with acute endovascular coiling of aneurysms and aggressive intensive care. Neurocrit Care 2011;14(3):341-7.
Mutoh T, Ishikawa T, Moroi J, Suzuki A, Yasui N. Impact of early surgical evacuation of sylvian hematoma on clinical course and outcome after subarachnoid hemorrhage. Neurol Med Chir (Tokyo) 2010;50(3):200-8.
Chiriac A, Poeată I, Baldauf J, Schroeder HW. Aneurysmal subarachnoid hemorrhage. Rev Med Chir Soc Med Nat Iasi 2010;114(1):120-8.
Yang J, Lin RS, Li ZQ, Qi JF, Ma SC, Liang JJ, Cun EH, Ren M, Yu CJ. Outcomes of early surgery combined with anti-vasospasm agents treat ruptured cranial aneurysms: an analysis of 127 cases. Zhonghua Yi Xue Za Zhi 2009;89(47):3350-2.
Pan JW, Zhan RY, Wen L, Tong Y, Wan S, Zhou YY. Ultra-early surgery for poor-grade intracranial aneurysmal subarachnoid hemorrhage: a preliminary study. Yonsei Med J 2009;50(4):521-4.
Shabehpoor M, Arjmand A, Safdari H, Azhari Sh, Naebaghaee H, Mohammadi H. Outcome of cerebral aneurysm surgery (early surgery-related complication and outcome after aneurysm clip placement). Iran J Surg 2006;14(2).
Qureshi AI, Sung GY, Suri MF, Straw RN, Guterman LR, Hopkins LN. Factors associated with aneurysm size in patients with subarachnoid hemorrhage: effect of smoking and aneurysm location. Neurosurgery 2000;46(1):44-50.
Firouznia K, Ghanaati H, Shabani Samghabadi MA, Shakiba M. Subarachnoid hemorrhage; An an-giographic evaluation in Iran. Iran J Radiol 2004;2(1-2):28-33.
Beseoglu K, Unfrau K, Steiger HJ, Hänggi D. Influenceof blood pressure variability on short-term outcome in patients with subarachnoid hemorrhage. Cen Eur Neurosurg 2010;71(2):69-74.
Risselada R, Lingsma HF, Bauer-Mehren A, Friedrich CM, Molyneux AJ, Kerr RS, Yarnold J, Sneade M, Steyerberg EW, Sturkenboom MC. Prediction of 60 day case-fatality after aneurysmal subarachnoid haemorrhage: results from the International Subarachnoid Aneurysm Trial (ISAT). Eur J Epidemiol 2010;25(4):261-6.
Shirao S, Yoneda H, Kunitsugu I, Ishihara H, Koizumi H, Suehiro E, Nomura S, Kato S, Fujisawa H, Suzuki M. Preoperative prediction of outcome in 283 poor-grade patients with subarachnoid hemorrhage: a project of the Chugoku-Shikoku Division of the Japan Neurosurgical Society. Cerebrovasc Dis 2010;30(2):105-13.
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Issue | Vol 49, No 7 (2011) | |
Section | Original Article(s) | |
Keywords | ||
Subarachnoid hemorrhage Time of surgery |
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