Aneurysmal surgery in the presence of angiographic vasospasm: an outcome assessment.
OBJECTIVE
The timing of aneurysmal surgery for patients presenting within the period at risk for vasospasm (VS) is controversial. The goal of this study is to review our experience of surgically treated patients in the presence of angiographic VS.


METHODS
From 1990-2004, 894 consecutive patients presented with an aneurysmal subarachnoid hemorrhage (SAH) and were treated with a policy of early surgery. We retrospectively analyzed the patients that had pre-operative angiographic VS. In this study, symptomatic VS was diagnosed when a decreased level of consciousness and/or focal deficit occurred after SAH in the presence of angiographic VS without confounding factors. Functional outcome was assessed three months after SAH using the Glasgow Outcome Scale.


RESULTS
Of the 40 patients studied, 62.5% were in good clinical grade Hunt & Hess (H&H 1-2) on admission; 25%, intermediate grade (H&H 3); 12.5%, poor grade (H&H 4-5). Surgery was performed 24 hours or less after initial angiography in 87.5% of patients and less than 48 hours in 97.5%. Pre-operative symptomatic VS was diagnosed in 25%. Post-operatively, angiographic VS was documented in 87.2%. Of the 30% of patients that presented post-operative symptomatic VS, 66.7% also demonstrated pre-operative symptomatic VS. The functional outcome was favorable in 92.5% of the studied patients. Two deaths occurred in patients presenting pre-operative early radiological and symptomatic VS.


CONCLUSIONS
Aneurysmal surgery, especially between 3-12 days following SAH, in the presence of asymptomatic pre-operative angiographic VS can be associated with a good outcome. Early surgery is not contra-indicated and might enable optimal treatment of VS.
McLaughlin
Nancy
N
Division of Neurosurgery, Department of Surgery, Centre Hospitalier de l'Université de Montreal, Hôpital Notre-Dame, Montreal, Quebec, Canada.
Bojanowski
Michel W
MW
D000293:Adolescent; D000328:Adult; D000368:Aged; D002533:Cerebral Angiography / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends; D002536:Cerebral Arteries / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000401:mortality / Q000592:standards* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D013346:Subarachnoid Space / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000401:mortality / Q000592:standards* / Q000706:statistics & numerical data; D020301:Vasospasm, Intracranial / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*