Volume 4, Issue 2 (Spring 2018)                   Iran J Neurosurg 2018, 4(2): 93-100 | Back to browse issues page

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Rahmanian A, Derakhshan N, Alibai E A. Outcome of In-Hospital Rebleeding and Early Aneurysm Rupture at the Referral Center. Iran J Neurosurg 2018; 4 (2) :93-100
URL: http://irjns.org/article-1-117-en.html
Outcome of In-Hospital Rebleeding and Early Aneurysm Rupture at the Referral Center
Abdolkarim Rahmanian1 , Nima Derakhshan * 2, Ehsan Ali Alibai1
1- Department of Neurosurgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
2- Department of Neurosurgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran , nima_med83@yahoo.com
Abstract:   (4352 Views)
Background and Aim: In-hospital rebleeding and early aneurysm rupture are major causes of mortality and morbidity in aneurysmal subarachnoid hemorrhage. Rebleeding may occur at the referring hospital, during transfer or at the referral neurovascular center prior to surgical or endovascular treatment. However, there has been no report regarding the rate of in-hospital rebleeding and early aneurysm rupture at the referral centers. This study aims to clarify the incidence, significance, management, and outcome of individuals who suffer in-hospital aneurysmal rebleeding and early aneurysm rupture at the referral hospital due to anterior circulation cerebral aneurysm to the time when its neck is visualized for clipping.
Methods and Materials/Patients: Among 617 patients with anterior circulation cerebral aneurysms who underwent operation between September 2010 and September 2017 at Neurovascular Unit of Namazi Hospital (main referral neurovascular center in southern Iran), 22 suffered rebleeding since the time of neuroradiologic diagnosis of aneurysm to intraoperative visualization of aneurysm for neck dissection. A surgical technique for fast access and securing the aneurysm is described in this article, too. The patients’ demographics were collected via hospital records in a retrospective fashion. Six-month functional outcome was obtained via OPD records as well as phone calls. Utilizing Independent t test, 1-way ANOVA, Kruskal-Wallis and Mann-Whitney tests in SPSS22, the effect of each study variable was evaluated during 6 months follow-up period. 
Results: Rebleeding occurred at different venues from CT angiography to frontal lobe retraction. Anterior communicating artery was the most common aneurysm to suffer in-hospital rebleeding and male gender was found as a risk factor. These patients have significantly higher bleeding amount and longer operative time (P<0.001), but still have a 68.2% chance of surviving with good functional recovery. Earlier in-hospital rebleedings are used to have worse outcomes (P=0.036 for GOS and 0.028 for mRS, respectively). 
Conclusion: Patients with in-hospital rebleeding and early aneurysm rupture at the referral hospitals will have a considerable chance for favorable outcome if they undergo aggressive surgical management emergently.
Keywords: Cerebral aneurysm, Ruptured aneurysm, Tertiary referral hospital, Outcome, Incidence
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Type of Study: Research | Subject: Vascular Neurosurgery
References
1. Hillman J, von Essen C, Leszniewski W, Johansson I. Significance of "ultra-early" rebleeding in subarachnoid hemorrhage. Journal of Neurosurgery. 1988; 68(6):901-907. [DOI:10.3171/jns.1988.68.6.0901] [PMID] [DOI:10.3171/jns.1988.68.6.0901]
2. Roos YBWEM, Beenen LFM, Groen RJM, Albrecht KW, Vermeulen M. Timing of surgery in patients with aneurysmal subarachnoid haemorrhage: rebleeding is still the major cause of poor outcome in neurosurgical units that aim at early surgery. Journal of Neurology, Neurosurgery & Psychiatry. 1997; 63(4):490-93. [DOI:10.1136/jnnp.63.4.490] [DOI:10.1136/jnnp.63.4.490]
3. Naidech AM, Janjua N, Kreiter KT, Ostapkovich ND, Fitzsimmons BF, Parra A, et al. Predictors and impact of aneurysm rebleeding after subarachnoid hemorrhage. Archives of Neurology. 2005; 62(3):410-16. [DOI:10.1001/archneur.62.3.410] [PMID] [DOI:10.1001/archneur.62.3.410]
4. Fujii Y, Takeuchi S, Sasaki O, Minakawa T, Koike T, Tanaka R. Ultra-early rebleeding in spontaneous subarachnoid hemorrhage. Journal of Neurosurgery. 1996; 84(1):35-42. [DOI:10.3171/jns.1996.84.1.0035] [PMID] [DOI:10.3171/jns.1996.84.1.0035]
5. Tang C, Zhang TS, Zhou LF. Risk factors for rebleeding of aneurysmal subarachnoid hemorrhage: A meta-analysis. PLoS ONE. 2014; 9(6):e99536. [DOI:10.1371/journal.pone.0099536] [PMID] [PMCID] [DOI:10.1371/journal.pone.0099536]
6. Brilstra EH, Rinkel GJ, Algra A, van Gijn J. Rebleeding, secondary ischemia, and timing of operation in patients with subarachnoid hemorrhage. Neurology. 2000; 55(11):1656-60. [DOI:10.1212/WNL.55.11.1656] [PMID] [DOI:10.1212/WNL.55.11.1656]
7. De Marchis GM, Lantigua H, Schmidt JM, et al. Impact of premorbid hypertension on haemorrhage severity and aneurysm rebleeding risk after subarachnoid haemorrhage. Journal of Neurology, Neurosurgery & Psychiatry. 2014; 85(1):56-9. [DOI:10.1136/jnnp-2013-305051] [PMID] [DOI:10.1136/jnnp-2013-305051]
8. Lin QS, Ping-Chen YXL, Lin ZY, Yu LH, Dai LS, Kang DZ. Systolic blood pressure variability is a novel risk factor for rebleeding in acute subarachnoid hemorrhage: A case-control study. Medicine. 2016; 95(11):e3028. [DOI:10.1097/MD.0000000000003028] [DOI:10.1097/MD.0000000000003028]
9. Anevrizmal KZBAT. Risk factors for rebleeding of aneurysmal subarachnoid hemorrhage based on the analysis of on-admission information. Turkish Neurosurgery. 2012; 22(6):675-81.
10. Beck J, Raabe A, Szelenyi A, Berkefeld J, Gerlach R, Setzer M, et al. Sentinel headache and the risk of rebleeding after aneurysmal subarachnoid hemorrhage. Stroke. 2006; 37(11):2733-37. [DOI:10.1161/01.STR.0000244762.51326.e7] [PMID] [DOI:10.1161/01.STR.0000244762.51326.e7]
11. Beck J, Raabe A, Szelenyi A, Berkefeld J, Gerlach R, Setzer M, et al. Endothelin polymorphisms as a risk factor for cerebral aneurysm rebleeding following aneurysmal subarachnoid hemorrhage. Clinical Neurology and Neurosurgery. 2017; 157:65-9. [DOI:10.1016/j.clineuro.2017.04.007] [PMID] [DOI:10.1016/j.clineuro.2017.04.007]
12. Rosenørn J, Eskesen V, Schmidt K, Rønde F. The risk of rebleeding from ruptured intracranial aneurysms. Journal of Neurosurgery. 1987; 67(3):329-32. [DOI:10.3171/jns.1987.67.3.0329] [PMID] [DOI:10.3171/jns.1987.67.3.0329]
13. Rahmanian A, Ghaffarpasand F, Alibai E, Choque-Velasquez J, Jahromi BR, Hernesniemi J. Surgical outcome of very small intracranial aneurysms utilizing the double clip technique. World Neurosurgery. 2018; 110:e605-e611. [DOI: 10.1016/j.wneu.2017.11.060] [DOI:10.1016/j.wneu.2017.11.060]
14. Boogaarts HD, van Lieshout JH, van Amerongen MJ, de Vries J, Verbeek ALM, Grotenhuis JA, et al. Aneurysm diameter as a risk factor for pretreatment rebleeding: A meta-analysis. Journal of Neurosurgery. 2015; 122(4):921-28. [DOI:10.3171/2014.12.JNS14931] [PMID] [DOI:10.3171/2014.12.JNS14931]
15. Rahmanian A, Ghaffarpasand F, Derakhshan N. Surgical outcome of patients with very small intracranial aneurysms: A single-center experience from southern Iran. World Neurosurgery. 2017; 98:470-8. [DOI:10.1016/j.wneu.2016.11.086] [PMID] [DOI:10.1016/j.wneu.2016.11.086]
16. Ren Y, Liu L, Sun H, Liu Y, Li H, Ma L, et al. Microsurgical versus endovascular treatments for blood-blister aneurysms of the internal carotid artery: A retrospective study of 83 patients in a single center. World Neurosurgery. 2018; 109:e615-e624. [DOI:10.1016/j.wneu.2017.10.048] [DOI:10.1016/j.wneu.2017.10.048]
17. Konczalla J, Gessler F, Bruder M, Berkefeld J, Marquardt G, Seifert V. Outcome after subarachnoid hemorrhage from blood blister-like aneurysm rupture depends on age and aneurysm morphology. World Neurosurgery. 2017; 105:944-51. [DOI:10.1016/j.wneu.2017.06.129] [DOI:10.1016/j.wneu.2017.06.129]
18. Fukuda H, Hayashi K, Yoshino K, Koyama T, Lo B, Kurosaki Y, et al. Impact of aneurysm projection on intraoperative complications during surgical clipping of ruptured posterior communicating artery aneurysms. Neurosurgery. 2015; 78(3):381-90. [DOI:10.1227/NEU.0000000000001131] [PMID] [DOI:10.1227/NEU.0000000000001131]
19. Zhao B, Yang H, Zheng K, Li Z, Xiong Y, Tan X, et al. Predictors of good functional outcomes and mortality in patients with severe rebleeding after aneurysmal subarachnoid hemorrhage. Clinical Neurology and Neurosurgery. 2016; 144:28-32. [DOI:10.1016/j.clineuro.2016.02.042] [PMID] [DOI:10.1016/j.clineuro.2016.02.042]
20. Kienzler J, Marbacher S, Remonda L, Soleman J, Ai Schlaeppi J, Leupold U et al. Outcome after in-hospital rebleeding of rupture of intracranial aneurysms. Journal of Neurological Surgery Part A: Central European Neurosurgery. 2016; 77(03):207-21. [DOI:10.1055/s-0035-1570007] [PMID] [DOI:10.1055/s-0035-1570007]
21. Jan Hillman, Steen Fridriksson, Ola Nilsson, Zhengquan Yu, Hans Säveland, Karl-Erik Jakobsson. Immediate administration of tranexamic acid and reduced incidence of early rebleeding after aneurysmal subarachnoid hemorrhage: A prospective randomized study. Journal of Neurosurgery. 2002; 97(4):771-8. [DOI:10.3171/jns.2002.97.4.0771] [PMID] [DOI:10.3171/jns.2002.97.4.0771]
22. Rahmanian A, Derakhshan N, Sisakht AM, Ziarati NK, Shahraki HR, Motamed S. Risk factors for unfavorable outcome in aneurysmal subarachnoid hemorrhage revisited; odds and ends. Bulletin of Emergency & Trauma. 2018; 6(2):13340. [DOI:10.29252/beat-060215] [PMID] [PMCID] [DOI:10.29252/beat-060215]
23. Rahmanian A, Sisakht A, Derakhshan N, Ziarati N, Shahraki H, Najafi B. Fresh frozen plasma versus albumin in treatment of cerebral vasospasm in subarachnoid hemorrhage: A historical cohort study. World Journal of Surgery. 2018; 1:1002.
24. Savastano LE, Bhambri A, Wilkinson DA, Pandey AS. Biology of cerebral aneurysm formation, growth, and rupture. In: Ringer A, editor. Intracranial Aneurysms. Amsterdam: Elsevier; 2018. [DOI:10.1016/B978-0-12-811740-8.00002-2]
25. Hendrix P, Foreman PM, Starke RM, Harrigan MR, Fisher WS, Vyas NA, et al. Associations of endothelin polymorphisms and aneurysm size at time of rupture. World Neurosurgery. 2017; 102:253-257. [DOI:10.1016/j.wneu.2017.03.041] [PMID] [DOI:10.1016/j.wneu.2017.03.041]
26. Griessenauer CJ, Starke RM, Foreman PM, Hendrix P, Harrigan MR, Fisher WS, et al. Associations between endothelin polymorphisms and aneurysmal subarachnoid hemorrhage, clinical vasospasm, delayed cerebral ischemia, and functional outcome. Journal of Neurosurgery. 2018; 128(5):1311-7. [PMID] [DOI:10.3171/2016.12.JNS162594] [PMID]
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