1
|
Wen LL, Zhou XM, Lv SY, Shao J, Wang HD, Zhang X. Outcomes of high-grade aneurysmal subarachnoid hemorrhage patients treated with coiling and ventricular intracranial pressure monitoring. World J Clin Cases 2021; 9:5054-5063. [PMID: 34307556 PMCID: PMC8283582 DOI: 10.12998/wjcc.v9.i19.5054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/08/2021] [Accepted: 05/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND High-grade aneurysmal subarachnoid hemorrhage is a devastating disease with a low favorable outcome. Elevated intracranial pressure is a substantial feature of high-grade aneurysmal subarachnoid hemorrhage that can result to secondary brain injury. Early control of intracranial pressure including decompressive craniectomy and external ventricular drainage had been reported to be associated with improved outcomes. But in recent years, little is known whether external ventricular drainage and intracranial pressure monitoring after coiling could improve outcomes in high-grade aneurysmal subarachnoid hemorrhage.
AIM To investigate the outcomes of high-grade aneurysmal subarachnoid hemorrhage patients with coiling and ventricular intracranial pressure monitoring.
METHODS A retrospective analysis of a consecutive series of high-grade patients treated between Jan 2016 and Jun 2017 was performed. In our center, followed by continuous intracranial pressure monitoring, the use of ventricular pressure probe for endovascular coiling and invasive intracranial pressure monitoring in the acute phase is considered to be the first choice for the treatment of high-grade patients. We retrospectively analyzed patient characteristics, radiological features, intracranial pressure monitoring parameters, complications, mortality and outcome.
RESULTS A total of 36 patients were included, and 32 (88.89%) survived. The overall mortality rate was 11.11%. No patient suffered from aneurysm re-rupture. The intracranial pressure in 33 patients (91.67%) was maintained within the normal range by ventricular drainage during the treatment. A favorable outcome was achieved in 18 patients (50%) with 6 mo follow-up. Delayed cerebral ischemia and Glasgow coma scale were considered as significant predictors of outcome (2.066 and -0.296, respectively, P < 0.05).
CONCLUSION Ventricular intracranial pressure monitoring may effectively maintain the intracranial pressure within the normal range. Despite the small number of cases in the current work, high-grade patients may benefit from a combination therapy of early coiling and subsequent ventricular intracranial pressure monitoring.
Collapse
Affiliation(s)
- Li-Li Wen
- Department of Neurosurgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, Jiangsu Province, China
| | - Xiao-Ming Zhou
- Department of Neurosurgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, Jiangsu Province, China
| | - Sheng-Yin Lv
- Department of Neurology, The Second Hospital of Nanjing, Nanjing 210003, Jiangsu Province, China
| | - Jiang Shao
- Department of Neurosurgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, Jiangsu Province, China
| | - Han-Dong Wang
- Department of Neurosurgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, Jiangsu Province, China
| | - Xin Zhang
- Department of Neurosurgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, Jiangsu Province, China
| |
Collapse
|
2
|
Ariyada K, Ohida T, Shibahashi K, Hoda H, Hanakawa K, Murao M. Long-term Functional Outcomes for World Federation of Neurosurgical Societies Grade V Aneurysmal Subarachnoid Hemorrhage after Active Treatment. Neurol Med Chir (Tokyo) 2020; 60:390-396. [PMID: 32669527 PMCID: PMC7431870 DOI: 10.2176/nmc.oa.2020-0052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
This study investigated the long-term outcomes of patients with World Federation of Neurosurgical Societies (WFNS) grade V aneurysmal subarachnoid hemorrhage (SAH) who underwent early aneurysm repair. We evaluated consecutive patients with WFNS grade V aneurysmal SAH from April 2010 to March 2015 who underwent aneurysm repair within 72 h after onset. We assessed the functional outcomes at discharge and 3 years after onset using the modified Rankin Scale (mRS). The primary outcome was defined as a favorable functional outcome (mRS ≤2). We identified 145 patients with grade V SAH during the study period. Of these, 44 patients (19 males and 25 females; median age, 64 years; range, 24–79 years) met the inclusion criteria. For aneurysm repair, surgical clipping and coiling were performed in 40 (90.9%) and 4 (9.1%) patients, respectively. Although no patient had a favorable functional outcome at discharge, 11 (25.0%) patients had a favorable functional outcome at the end of follow-up. The number of patients with a favorable outcome significantly increased during the first year (P = 0.012) and during the follow-up period (P <0.001). Patients who underwent active rehabilitation had significant improvement. Our study showed that one-fourth of the patients who underwent early aneurysm repair with WFNS grade V SAH achieved a mRS score of ≤2 over a 3-year period. It might be important to consider age and rehabilitation for better clinical outcomes. Larger studies are required to adequately assess the long-term functional outcomes and other multi-faceted prognoses.
Collapse
Affiliation(s)
- Kenichi Ariyada
- Department of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital
| | - Tomoya Ohida
- Department of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital
| | - Keita Shibahashi
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital
| | - Hidenori Hoda
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital
| | - Kazuo Hanakawa
- Department of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital
| | - Masahiko Murao
- Department of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital
| |
Collapse
|
3
|
de Oliveira Manoel AL, Mansur A, Silva GS, Germans MR, Jaja BNR, Kouzmina E, Marotta TR, Abrahamson S, Schweizer TA, Spears J, Macdonald RL. Functional Outcome After Poor-Grade Subarachnoid Hemorrhage: A Single-Center Study and Systematic Literature Review. Neurocrit Care 2017; 25:338-350. [PMID: 27651379 DOI: 10.1007/s12028-016-0305-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND PURPOSE Poor-grade subarachnoid hemorrhage (SAH) (World Federation of Neurosurgical Societies grade 4 and 5) is associated with high mortality rates and unfavorable functional outcomes. We report a single-center cohort of poor-grade SAH patients, combined with a systematic review of studies reporting functional outcome in the poor-grade SAH population. METHODS Data on a cohort of poor-grade SAH patients treated between 2009 and 2013 were retrospectively collected and combined with a systematic review (from inception to November 2015; PubMed, Embase). Two reviewers assessed the studies independently based on predefined inclusion criteria: consecutive poor-grade SAH, functional outcome measured at least 3 months after hemorrhage, and the report of patients who died before aneurysm treatment. RESULTS The search yielded 329 publications, and 23 met our inclusion criteria with 2713 subjects enrolled from 1977 to 2014 in 10 countries (including 179 poor-grade patients from our cohort). Mortality rate was 60 % (1683 patients), of which 806 (29 %) died before and 877 (31 %) died after aneurysm treatment, respectively. Treatment was undertaken in 1775 patients (1775/2826-63 %): 1347 by surgical clipping (1347/1775-76 %) and 428 (428/1775-24 %) by endovascular methods. Outcome was favorable in 794 patients (28 %) and unfavorable in 1867 (66 %). When the studies were grouped into decades, favorable outcome increased from 13 % in the late 1970s to early 1980s to 35 % in the late 1980s to early 1990s, and remained unchanged thereafter. CONCLUSION Although mortality remains high in poor-grade SAH patients, a favorable functional outcome can be achieved in approximately one-third of patients. The development of new diagnostic methods and implementation of therapeutic approaches were probably responsible for the decrease in mortality and improvement in the functional outcome from 1970 to the 1990s. The plateau in functional outcome seen thereafter might be explained by the treatment of sicker and older patients and by the lack of new therapeutic interventions specific for SAH.
Collapse
Affiliation(s)
- Airton Leonardo de Oliveira Manoel
- Department of Medical Imaging, Interventional Neuroradiology, St. Michael's Hospital, University of Toronto, 3-141 CC, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. .,Department of Critical Care Medicine, Trauma and Neurosurgical Intensive Care Unit, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada. .,Neuroscience Research Program, Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Canada. .,Neurology and Neurosurgery Department, Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Ann Mansur
- Neuroscience Research Program, Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Gisele Sampaio Silva
- Neurology and Neurosurgery Department, Universidade Federal de São Paulo, São Paulo, Brazil.,Instituto Israelita de Pesquisa Albert Einstein, Neurology Program, São Paulo, Brazil
| | - Menno R Germans
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Blessing N R Jaja
- Neuroscience Research Program, Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Canada
| | - Ekaterina Kouzmina
- Department of Medical Imaging, Interventional Neuroradiology, St. Michael's Hospital, University of Toronto, 3-141 CC, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Thomas R Marotta
- Department of Medical Imaging, Interventional Neuroradiology, St. Michael's Hospital, University of Toronto, 3-141 CC, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Neuroscience Research Program, Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Canada
| | - Simon Abrahamson
- Department of Critical Care Medicine, Trauma and Neurosurgical Intensive Care Unit, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.,Department of Anesthesiology, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Tom A Schweizer
- Neuroscience Research Program, Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Canada
| | - Julian Spears
- Neuroscience Research Program, Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Canada.,Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - R Loch Macdonald
- Neuroscience Research Program, Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Canada.,Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
4
|
Somatosensory and Brainstem Auditory Evoked Potentials Assessed between 4 and 7 Days after Severe Stroke Onset Predict Unfavorable Outcome. BIOMED RESEARCH INTERNATIONAL 2015; 2015:196148. [PMID: 26798633 PMCID: PMC4698544 DOI: 10.1155/2015/196148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 11/12/2015] [Accepted: 11/19/2015] [Indexed: 12/11/2022]
Abstract
Our objective was to explore the best predictive timing of short-latency somatosensory evoked potentials (SLSEP) and brainstem auditory evoked potentials (BAEP) for unfavorable outcomes in patients with early stage severe stroke. One hundred fifty-six patients with acute severe supratentorial stroke were monitored according to SLSEP, BAEP, and the Glasgow Coma Scale (GCS) at 1-3 days and 4-7 days after the onset of stroke. All patients were followed up for outcomes at 6 months after onset using the modified Rankin Scale (mRS), with a score of 5-6 considered unfavorable. The predictive values of SLSEP, BAEP, and the GCS at 1-3 days were compared with 4-7 days after onset. Our results show that, according to the analysis of prognostic authenticity, the predictive values of SLSEP and BAEP at 4-7 days after stroke onset improved when compared with the values at 1-3 days for unfavorable outcomes. Most of the patients with change of worsening evoked potentials from 1-3 days to 4-7 days after onset had unfavorable outcomes. In conclusion, SLSEP and BAEP assessed at 4-7 days after onset predicted unfavorable outcomes for acute severe stroke patients. The worsening values of SLSEP and BAEP between 1-3 days and 4-7 days also present a prognostic value.
Collapse
|
5
|
Fukui K, Suzuki O, Ito S, Miyazaki M, Hattori K, Osawa H. Comparison of Endovascular and Surgical Treatment for Ruptured Cerebral Aneurysms with respect to Short and Long-Term Outcome. Interv Neuroradiol 2004; 10:129-34. [PMID: 20587224 DOI: 10.1177/159101990401000204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2004] [Accepted: 03/21/2004] [Indexed: 12/13/2022] Open
Abstract
SUMMARY We compared the treatment for ruptured aneurysms from the clinical and radiological follow-ups after endovascular (GDC) or surgical treatment. There were 142 surgically treated cases and 38 endovascular treated cases from May 1997 to December 2001. In endovascular cases there were four A-com, four MCA, 12 ICA and 18 posterior circulation aneurysms. In surgical cases, there were 53 A-com ACA, 51 MCA, 36 ICA and two posterior circulation aneurysms. The clinical outcomes of endovascular and surgical treatments were correlated with the H & H grades before treatments. At short stage, 71% of endovascular and 78.2% of surgical cases showed a favorable outcome (GOS GR or MD) (p=0.3). Long-term clinical follow ups (14.5 to 58 months) showed 77.7% of endovascular and 87.7% of surgical cases resulted in GR or MD (p=0.17). In endovascular cases, 22.2% showed recurrence during the follow-up period and five of them needed re-treatment. We experienced failed endovascular approach at acute stage in seven cases which changed to surgery. In conclusion, the short and long term clinical results of endovascular treatment were acceptable comparing surgical clipping. High recurrence rate after GDC treatment did not permit future completeness of the treatment. Still the treatment alternative between endovascular or surgical treatment may change depending on the criteria of each institution, attention should be paid to the disadvantages of endovascular treatment as the first choice for ruptured aneurysms.
Collapse
Affiliation(s)
- K Fukui
- Department of Neurosurgery, Nagoya Ekisaikai Hospoital, Nagoya, Japan
| | | | | | | | | | | |
Collapse
|