医学
剪裁(形态学)
蛛网膜下腔出血
动脉瘤
外科
脑积水
闭塞
改良兰金量表
格拉斯哥结局量表
放射科
显微外科
血管内卷取
前交通动脉
血管痉挛
神经外科
血管内治疗
回顾性队列研究
格拉斯哥昏迷指数
缺血
心脏病学
哲学
语言学
缺血性中风
作者
Jan‐Karl Burkhardt,Ethan A. Winkler,Jonathan Weller,Michael T. Lawton
标识
DOI:10.1016/j.wneu.2020.06.186
摘要
Background The optimal timing for the surgical treatment of additional unruptured aneurysms in patients with multiple aneurysms and aneurysmal subarachnoid hemorrhage (aSAH) is unknown. Therefore, we analyzed the results of early versus delayed microsurgical treatment of unruptured aneurysms when multiple aneurysms were present in the setting of aSAH. Methods The medical records from a consecutive, single-surgeon, 19-year experience of all patients with aSAH and additional unruptured aneurysms treated with a second surgery were reviewed retrospectively. Early treatment was defined as treatment within 30 days and delayed treatment as treatment more than 30 days after the initial surgery for aSAH. Results A total of 85 patients with aSAH and multiple aneurysms were identified. Early (n = 55; 65%) or delayed (n = 30; 35%) clipping was performed for additional unruptured aneurysms. Intraoperative rupture (P = 0.028), higher Fisher grade (P = 0.046), multiple additional unruptured aneurysms (P = 0.04), and large aneurysm size of either the ruptured aneurysm (P = 0.034) or unruptured aneurysm (P = 0.022) were significant factors favoring early treatment. Significant differences were not observed with respect to outcome (modified Rankin scale), unfavorable modified Rankin scale changes between the first surgery and last follow-up, aneurysm occlusion, and shunt-dependent hydrocephalus. No ruptures of untreated aneurysms during the follow-up course were observed. Conclusions Both early and delayed surgical treatment of unruptured aneurysms in the setting of aSAH are safe. Factors prompting earlier intervention might include multiple additional aneurysms, larger aneurysms, and intraoperative aneurysm rupture, which could suggest a destabilized arterial wall. Delayed treatment is advisable for patients with a poor clinical presentation, greater underlying brain injury, and a swollen brain requiring decompressive craniectomy to allow time for recovery.
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