Outcome of aneurysmal subarachnoid haemorrhage following the introduction of papaverine angioplasty.
This is a prospective study reporting the impact of angiographic vasospasm on the outcome following aneurysmal subarachnoid haemorrhage utilising a common regimen that includes nimodipine and angioplasty. The first 100 patients suffering an aneurysmal subarachnoid haemorrhage treated by surgery and this angioplasty driven protocol are reviewed. Angiography was performed if the Glasgow Coma Score (GCS) fell by two, a focal neurological deficit developed, hyponatraemia was detected, or routinely on days 5-7 following the subarachnoid haemorrhage. Angioplasty with papaverine was administered intra-arterially in all patients with significant angiographic vasospasm. Neurological deficits on admission were not present in 49% and associated with a GCS less than 14 in 38%. Angiographic vasospasm was detected in 48% of patients (all of whom received papaverine). Overall 3 month outcome was normal in 60%, neurological deficit but independence with regard to activities of daily living in 18%, loss of independence in 17%, and death in 5% of cases. Analysis of admission neurological condition (GCS < vs GCS > 13), presence of angiographic vasospasm, aneurysm size (less than or greater than 1.5 cm), and aneurysm circulation (anterior vs posterior) on outcome (normal vs abnormal) found that only admission neurological condition significantly influenced outcome (P < 0.0001). The results suggest that with the protocol of nimodipine and angioplasty the impact of vasospasm on outcome is far less significant than the clinical severity of the initial haemorrhage. This is in contradistinction to the experience with aneurysmal subarachnoid haemorrhage prior to this regimen (nimodipine and angioplasty) where vasospasm was the most significant determinant of a poor outcome.
Morgan
M
M
Department of Neurosurgery, Royal North Shore Hospital, Sydney, Australia.
Halcrow
S
S
Sorby
W
W
Grinnell
V
V