Management of subarachnoid hemorrhage with intracerebral hematoma: clipping and clot evacuation versus coil embolization followed by clot evacuation

被引:26
作者
de los Reyes, Kenneth [1 ]
Patel, Aman [1 ]
Bederson, Joshua B. [1 ]
Frontera, Jennifer A. [1 ]
机构
[1] Mt Sinai Sch Med, Dept Neurosurg, New York, NY 10010 USA
关键词
CEREBRAL ANEURYSMS; PROGNOSTIC-FACTORS; FISHER SCALE; RISK-FACTORS; RUPTURE; SURGERY; COMPLICATIONS; INFECTIONS; EXPERIENCE; MORTALITY;
D O I
10.1136/neurintsurg-2011-010204
中图分类号
R445 [影像诊断学];
学科分类号
100207 ;
摘要
Background Aneurysmal subarachnoid hemorrhage (SAH) with associated intracerebral hemorrhage (ICH) is often treated with concomitant surgical clipping and ICH evacuation. The aim of this study was to determine if aneurysm coiling followed by ICH evacuation is a viable alternative treatment. Methods A retrospective review was conducted between July 2000 and March 2009 of patients with aneurysmal SAH plus ICH (>30 ml or with midline shift >5 mm) who underwent aneurysm repair (either coiling or clipping) and craniotomy for ICH evacuation. Demographic and radiographic criteria, time to aneurysm protection, length of stay (LOS), treatment complications, discharge disposition and 3 month functional outcome were compared between groups. Results Of 18 SAH+ICH patients, 10 underwent aneurysm coiling followed by ICH evacuation and eight underwent clipping with ICH evacuation. Compared with clipped patients, coiled patients had a lower Glasgow Coma Scale score (median 5.5 vs 7.5), higher ICH score (median 3 vs 2), worse modified Fisher score (median 4 vs 3) and higher rate of herniation at presentation (50% vs 25%). Median time to aneurysm protection was shorter in coiled patients (299 vs 885 min, p<0.001). Comparing coiled with clipped patients, rates of death (30% vs 25%), poor outcome (70% vs 50%), median ICU LOS (20 vs 22 days), median hospital LOS (27 vs 29 days) and total median direct costs ($64 537 vs $61 243) were similar, as were complication rates (all p>0.05). Conclusions Coiling followed by ICH evacuation is associated with faster time to aneurysm protection and similar outcome, LOS and cost as clipping and evacuation. This may be a viable alternative to clipping and ICH evacuation.
引用
收藏
页码:99 / 103
页数:5
相关论文
共 35 条
[1]  
Badrinath SS, 1995, OPHTHALMIC SURG LAS, V26, P535
[2]   Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage A Statement for Healthcare Professionals From a Special Writing Group of the Stroke Council, American Heart Association [J].
Bederson, Joshua B. ;
Connolly, E. Sander, Jr. ;
Batjer, H. Hunt ;
Dacey, Ralph G. ;
Dion, Jacques E. ;
Diringer, Michael N. ;
Duldner, John E., Jr. ;
Harbaugh, Robert E. ;
Patel, Aman B. ;
Rosenwasser, Robert H. .
STROKE, 2009, 40 (03) :994-1025
[3]   INITIAL AND RECURRENT BLEEDING ARE THE MAJOR CAUSES OF DEATH FOLLOWING SUBARACHNOID HEMORRHAGE [J].
BRODERICK, JP ;
BROTT, TG ;
DULDNER, JE ;
TOMSICK, T ;
LEACH, A .
STROKE, 1994, 25 (07) :1342-1347
[4]   Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage - The Fisher scale revisited [J].
Claassen, J ;
Bernardini, GL ;
Kreiter, K ;
Bates, J ;
Du, YLE ;
Copeland, D ;
Connolly, ES ;
Mayer, SA .
STROKE, 2001, 32 (09) :2012-2020
[5]   Venous thromboembolism prophylaxis: Patients at high risk to fail intermittent pneumatic compression [J].
Clarke-Pearson, DL ;
Dodge, RK ;
Synan, I ;
McClelland, RC ;
Maxwell, GL .
OBSTETRICS AND GYNECOLOGY, 2003, 101 (01) :157-163
[6]   Mortality rates after subarachnoid hemorrhage: variations according to hospital case volume in 18 states [J].
Cross, DT ;
Tirschwell, DL ;
Clark, MA ;
Tuden, D ;
Derdeyn, CP ;
Moran, CJ ;
Dacey, RG .
JOURNAL OF NEUROSURGERY, 2003, 99 (05) :810-817
[7]   Predicting pulmonary complications after nonthoracic surgery: A systematic review of blinded studies [J].
Fisher, BW ;
Majumdar, SR ;
McAlister, FA .
AMERICAN JOURNAL OF MEDICINE, 2002, 112 (03) :219-225
[8]   Prediction of symptomatic vasospasm after subarachnoid hemorrhage: The modified Fisher scale [J].
Frontera, Jennifer A. ;
Claassen, Jan ;
Schmidt, J. Michael ;
Wartenberg, Katja E. ;
Temes, Richard ;
Connolly, E. Sander, Jr. ;
MacDonald, R. Loch ;
Mayer, Stephan A. .
NEUROSURGERY, 2006, 59 (01) :21-26
[9]   SUBARACHNOID HEMORRHAGE AND INTRACEREBRAL HEMATOMA: INCIDENCE, PROGNOSTIC FACTORS, AND OUTCOME [J].
Gueresir, Erdem ;
Beck, Juergen ;
Vatter, Hartmut ;
Setzer, Matthias ;
Gerlach, Ruediger ;
Seifert, Volker ;
Raabe, Andreas .
NEUROSURGERY, 2008, 63 (06) :1088-1093
[10]   Short-Term Antifibrinolytic Therapy Before Early Aneurysm Treatment in Subarachnoid Hemorrhage: Effects on Rehemorrhage, Cerebral Ischemia, and Hydrocephalus [J].
Harrigan, Mark R. ;
Rajneesh, Kiran F. ;
Ardelt, Agnieszka A. ;
Fisher, Winfield S. .
NEUROSURGERY, 2010, 67 (04) :935-939