MR imaging of the brain 1 year after aneurysmal subarachnoid hemorrhage: randomized study comparing surgical with endovascular treatment.
OBJECTIVE
To prospectively evaluate, with magnetic resonance (MR) imaging, long-term outcome of the brain after endovascular versus neurosurgical treatment for aneurysmal subarachnoid hemorrhage (aSAH).


METHODS
Institutional review board approval and informed consent were obtained. One hundred sixty-eight (77 men, 91 women; mean age +/- standard deviation, 51 years +/- 13) patients were randomly assigned to surgical versus endovascular treatment of the ruptured aneurysm with 138 (67 endovascular, 71 surgical) MR examinations 1 year after aSAH. The presence, localization, volumes, and cause of lesions were analyzed with chi(2), Mann-Whitney U, and Student t tests. Furthermore, correlation between MR-detectable brain parenchymal high-signal intensity (SI) lesions on T2- and intermediate-weighted MR images and neuropsychologic outcome was evaluated by using Spearman correlation coefficient.


RESULTS
Only 44 (31.9%) of 138 patients had no lesions associated with aSAH. According to intention to treat, lesions were more frequent after surgical rather than endovascular treatment, predominating in the frontal (surgical: n = 50, [70.4%] vs endovascular: n = 34 [50.7%], P = .018) and temporal (n = 34 [47.9%] vs n = 15 [22.4%], P = .002) lobes. Only endovascular patients had subtentorial lesions (n = 4 [6.0%], P = .037). Ischemic lesions in the parental artery territory were more frequent in surgical (n = 33 [46.5%]) than in endovascular (n = 15 [22.4%], P = .003) patients, with corresponding mean lesion volumes of 20.9 cm(3) +/- 46.5 versus 17.6 cm(3) +/- 35.8 (P = .209). Ischemic lesions in remote vascular territories were equal in frequency and size. Retraction injuries were common in the surgical (n = 40, [56.3%]) treatment group. Ischemic lesion volumes correlated with neuropsychologic test scores.


CONCLUSIONS
Parenchymal high-SI lesions on T2- and intermediate-weighted MR images are more frequent after early surgical rather than endovascular treatment of the ruptured aneurysm, and lesion volumes correlate with the neuropsychologic test performance.
Bendel
Paula
P
Department of Clinical Radiology, Kuopio University Hospital and Kuopio University, Puijonlaaksontie 2, 70210 Kuopio, Finland. paula.bendel@kuh.fi
Koivisto
Timo
T
Könönen
Mervi
M
Hänninen
Tuomo
T
Hurskainen
Heleena
H
Saari
Tapani
T
Vapalahti
Matti
M
Hernesniemi
Juha
J
Vanninen
Ritva
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology* / Q000601:surgery; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D013345:Subarachnoid Hemorrhage / Q000473:pathology* / Q000628:therapy*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*