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Volume 4, Issue 2 (Spring 2018)
Iran J Neurosurg 2018, 4(2): 75-82 |
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Alijani B, Emamhadi M, Yosefzadeh Chabok S, Jafari S, Naseri A. Surgical Protocol and Outcome of 60 Cases With Intracranial Aneurysm. Iran J Neurosurg 2018; 4 (2) :75-82
URL: http://irjns.org/article-1-97-en.html
URL: http://irjns.org/article-1-97-en.html
Babak Alijani1 
, Mohamadreza Emamhadi1 , Shahrokh Yosefzadeh Chabok2 , Seyfollah Jafari1 , Amin Naseri * 3
, Mohamadreza Emamhadi1 , Shahrokh Yosefzadeh Chabok2 , Seyfollah Jafari1 , Amin Naseri * 3
1- Associate Professor of Neurosurgery, Department of Neurosurgery, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
2- Associate Professor of Neurosurgery, Guilan Road Trauma Research Center, Department of Neurosurgery, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
3- Associate Professor of Neurosurgery, Department of Neurosurgery, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran ,dr.amin_ms84@yahoo.com
2- Associate Professor of Neurosurgery, Guilan Road Trauma Research Center, Department of Neurosurgery, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
3- Associate Professor of Neurosurgery, Department of Neurosurgery, Poursina Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran ,
Abstract: (5744 Views)
Background and Aim: This study aimed to present the results of early and delayed operation on patients with ruptured brain aneurysms. In addition to comparing the results and rates of morbidity and mortality in the surgical procedure and identifying the effective factors, this study aimed to provide methods to improve the treatment of brain aneurysm.
Methods and Materials/Patients: This was a retrospective study on 60 patients with a definitive diagnosis of brain aneurysm admitted to Neurosurgery Ward of Poursina Hospital, Rasht, Iran from 2009 to 2013.
Results: 7(11.7%) patients on the first 3 days and 37(61.7%) patients on the days 4-14 and 16(26.7%) after 2 weeks and selectively underwent surgery. In total, 11.7% of patients died and 15% developed severe complications. In the group underwent surgery on the first 3 days, 2(28.5%) patients died and 2 experienced severe complications. In the second group (in 4-14 days), 4(10.8%) patients died and 5(13.5%) suffered from severe complications, and in the group (16 patients) with delayed surgeries, 1(6.2%) patient died and 2(12.5%) suffered from severe complications. Neurological grading and operation time were important factors in complications and mortality of patients.
Conclusion: This study showed that Hunt and Hess neurological grading score has a direct relationship with increased morbidity and mortality rates, while delayed operation is associated with a reduction in morbidity and mortality. Given the complications of early aneurysm surgery (during the first 3 days) compared with delayed surgery, and also most of these patients die due to vasospasm or recurrent hemorrhage before the onset of a delayed phase, performing early surgery in these patients requires further evaluation. According to this study, the reduction of each episode of occlusion with temporary clipping will result in fewer complications.
Methods and Materials/Patients: This was a retrospective study on 60 patients with a definitive diagnosis of brain aneurysm admitted to Neurosurgery Ward of Poursina Hospital, Rasht, Iran from 2009 to 2013.
Results: 7(11.7%) patients on the first 3 days and 37(61.7%) patients on the days 4-14 and 16(26.7%) after 2 weeks and selectively underwent surgery. In total, 11.7% of patients died and 15% developed severe complications. In the group underwent surgery on the first 3 days, 2(28.5%) patients died and 2 experienced severe complications. In the second group (in 4-14 days), 4(10.8%) patients died and 5(13.5%) suffered from severe complications, and in the group (16 patients) with delayed surgeries, 1(6.2%) patient died and 2(12.5%) suffered from severe complications. Neurological grading and operation time were important factors in complications and mortality of patients.
Conclusion: This study showed that Hunt and Hess neurological grading score has a direct relationship with increased morbidity and mortality rates, while delayed operation is associated with a reduction in morbidity and mortality. Given the complications of early aneurysm surgery (during the first 3 days) compared with delayed surgery, and also most of these patients die due to vasospasm or recurrent hemorrhage before the onset of a delayed phase, performing early surgery in these patients requires further evaluation. According to this study, the reduction of each episode of occlusion with temporary clipping will result in fewer complications.
Type of Study: Research |
Subject:
Vascular Neurosurgery
References
1. Suarez JI, Tarr RW, Selman WR: Aneurysmal subarac hnoid hemorrhage. New England Journal of Medicine. 2006; 354(4):387-96. [DOI:10.1056/NEJMra052732] [PMID] [DOI:10.1056/NEJMra052732]
2. Koivisto T, Vanninen R, Hurskainen H, Saari T, Hernesniemi JA, Vapalahti MP. Outcomes of early endovascular versus surgical treatment of ruptured cerebral aneurysms: A prospective randomized study. Stroke. 2000; 31:2369-77. [DOI:10.1161/01.STR.31.10.2369] [DOI:10.1161/01.STR.31.10.2369]
3. Mashhadinejad H, Samini F, Faraji M, Mashhadinejad H. [Brain aneurysms and the results of their surgery in Mashhad Ghaem Hospital during 1998-2007 (Persian)]. Iranian Journal of Surgery. 2012; 19(4):28-35.
4. Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, Holman R. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in2143 patients with ruptured intracranial aneurysms: A randomised trial. Lancet. 2002; 360(9342):1267-74. [DOI:10.1016/S0140-6736(02)11314-6] [DOI:10.1016/S0140-6736(02)11314-6]
5. Cesarini KG, Hardemark HG, Persson l. Improved survival after aneurysmal subarachnoid hemorrhage: Review of case management during a 12- year period. Journal of Neurosurgery. 1999; 90(4):664-72. [DOI:10.3171/jns.1999.90.4.0664] [PMID] [DOI:10.3171/jns.1999.90.4.0664]
6. Ogungbo B, Gregson BA, Blackbum A, Mendelow AD. Trends over time in the management of sub arachnoid hemorrhage in Newcastle: Review of 1609 patients. British Journal of Neurosurgery. 2001; 15(5):388-95. [DOI:10.1080/02688690120082387] [PMID] [DOI:10.1080/02688690120082387]
7. Yasargil MG. Reflections on the thesis prospective outcome study of aneurysmal subarachnoid hemorrhagel of Dr. Timo Koivisto. Kuopio: Kuopio University Publication; 2002.
8. McLaughlin N, Bojanowski MW. Early surgery-related complications after aneurysm clip placement: An analysis of causes and patient outcomes. Journal of Neurosurgery. 2004; 101(4):600-6. [DOI:10.3171/jns.2004.101.4.0600] [PMID] [DOI:10.3171/jns.2004.101.4.0600]
9. Sundt TM Jr, Kobayashi S, Fode NC, Whisnant JP. Results and complications of surgical management of 809 intracranial aneurysms in 722 cases. Related and unrelated to grade of patient, type of aneurysm, and timing of surgery. Journal of Neurosurgery. 1982; 56(6):753-65. [DOI:10.3171/jns.1982.56.6.0753] [PMID] [DOI:10.3171/jns.1982.56.6.0753]
10. Wermer MJ, van der Schaaf IC, Velthuis BK, Algra A, Buskens E, Rinkel GJ, et al. Follow-up screening after subarachnoid haemorrhage: Frequency and determinants of new aneurysms and enlargement of existing aneurysms. Brain. 2005; 128(Pt 10):2421-9. [DOI:10.1093/brain/awh587] [PMID] [DOI:10.1093/brain/awh587]
11. Inagawa T. Trend in incidence and case fatality rates of aneurysmal subarachnoid hemorrhage in Izumo city, Japan, between1980-1989 and 1990-1998. Stroke. 2001; 32(7):1499-507. [DOI:10.1161/01.STR.32.7.1499] [PMID] [DOI:10.1161/01.STR.32.7.1499]
12. 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) (Persian)]. Iranian Journal of surgery. 2006; 14(2):55-64.
13. Zhao L, Zhang L, Zhang X, Li Zh, Tian L, Wang YX. An analysis of 1256 cases of sporadic ruptured cerebral aneurysm in a single Chinese institution. PLOS ONE. 2014; 9(1). [DOI:10.1371/journal.pone.0085668] [DOI:10.1371/journal.pone.0085668]
14. Säveland H, Hillman J, Brandt L, Jakobsson KE, Edner G, Algers G. Causes of morbidity and mortality, with special reference to surgical complications, after early aneurysm operation: A prospective, one-year study from neurosurgical units in Sweden. Acta Neurologica Scandinavica. 1993; 88(4):254-8. [PMID] [DOI:10.1111/j.1600-0404.1993.tb04231.x] [PMID]
15. Fridriksson S, Säveland H, Jakobsson KE, Edner G, Zygmunt S, Brandt L, et al. Intra operative complications in aneurysm surgery: A prospective national study. Journal of Neurosurgery. 2002; 96(3):515-22. [DOI:10.3171/jns.2002.96.3.0515] [PMID] [DOI:10.3171/jns.2002.96.3.0515]
16. CARAT Investigators. Rates of delayed rebleeding from intracranial aneurysms are low after surgical and endovascular treatment. Stroke. 2006; 37(6):1437-42. [DOI:10.1161/01.STR.0000221331.01830.ce] [PMID] [DOI:10.1161/01.STR.0000221331.01830.ce]
17. Hernesniemi J, Vapalahti M, Niskanen M, Kari A. Management and outcome of vertebrobasilar artery aneurysms by early surgery. Neurosurgery. 1992; 31(5):857-62. [DOI:10.1227/00006123-199211000-00005] [DOI:10.1227/00006123-199211000-00005]
18. Naidech AM, Janjua N, Kreiter KT, Ostapkovich ND, Fitzsimmons BF, Parra A, et al. Predictors and impact of aneurysm rebleeding after subarachnoid hemorrhage. JAMA Neurology. 2005; 62(3):410-6. [DOI:10.1001/archneur.62.3.410] [PMID] [DOI:10.1001/archneur.62.3.410]
19. Auer LM. Unfavorable outcome following early surgical repair of ruptured cerebral aneurysms a critical review of 238 patients. Surgical Neurology. 1991; 35(2):152-8. [DOI:10.1016/0090-3019(91)90269-F] [DOI:10.1016/0090-3019(91)90269-F]
20. 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. Journal of Neurosurgery. 1990; 73(1):18-36. [DOI:10.3171/jns.1990.73.1.0037] [PMID] [DOI:10.3171/jns.1990.73.1.0037]
21. Borzoyeh F, Sedighi A, Mohammadi ARM. [Outcome of surgical treatment of 85 patients with intracranial aneurysm in Shohaday-eTajris (Persian)]. Pejouhandeh. 2004; 9(40):203-7.
22. Brothers MF, Holgate RC. Intracranial angioplasty for treatment of vasospasm after subarachnoid hemorrhage: Technique and modifications to improve branch access. American Journal of Neuroradiology. 1990; 11(2):239-47. [PMID] [PMID]
23. Le Roux PD, Newell DW, Eskridge J, Mayberg MR, Winn HR. Severe symptomatic vasospasm: The role of immediate postoperative angioplasty. Journal of Neurosurgery. 1994; 80(2):224-9. [DOI:10.3171/jns.1994.80.2.0224] [PMID] [DOI:10.3171/jns.1994.80.2.0224]
24. Peerlees SJ, Hernesniemi JA, Gutman FB, Drake CG. Early surgery for ruptured vertebrobasilar aneurysms. Journal of Neurosurgery. 1994; 80(4):643-9. [DOI:10.3171/jns.1994.80.4.0643] [PMID] [DOI:10.3171/jns.1994.80.4.0643]
25. Milhorat TH, Krautheim M. Results of early and delayed operations for ruptured intracranial aneurysms in two series of 100 consecutive patients. Surgical Neurology. 1986; 26(2):123-8. [DOI:10.1016/0090-3019(86)90364-2] [DOI:10.1016/0090-3019(86)90364-2]
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This is an open access article distributed under the terms of the Creative Commons Attribution License (CC-By-NC), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
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