Interdisciplinary treatment selection in admitted patients with acute subarachnoid hemorrhage.
OBJECTIVE
To review the angiographic and clinical outcomes from acute (first 6 hours after bleeding) interdisciplinary treated patients with ruptured intracranial aneurysm.


METHODS
An interventional neuroradiologist and a neurosurgeon set the emergent treatment of 100 consecutive patients with subarachnoid hemorrhage (SAH) harboring 111 cerebral aneurysms. Decisions were based on the patient's clinical condition, aneurysm's morphology and location, presence of intracranial mass-occupying process (IMOP), angiographic flow distribution patterns and treatment-related risk profit. The benefits of a joined case assessment were retrospectively analyzed, comparing our clinical and radiological results with those of the averaged literature series.


RESULTS
Initially, 39 aneurysms in 34 patients were endovascularly (EV) treated and 68 aneurysms in 66 patients were surgically (S) treated. Four nonruptured aneurysms remain under control. Complete radiological aneurysm occlusion was initially achieved in 35 (89.7%) EV and 62 (95.4%) S treated aneurysms. Twenty-six patients in poor clinical condition with IMOP as well as ten patients with distally located, 18 with EV unfavorable and 12 with highly expected recanalization rate aneurysms required S treatment. Four aneurysm remnants (two EV and two S) remain unchanged. Two EV treated aneurysms grew and were surgically occluded, and another three patients required an additional coiling procedure after recanalization. Favorable evolution was observed in 27 (79.4%) EV and 55 (83.3%) S treated patients. Computed tomography-documented rebleedings (7:1), angiographic vasospasm (3:5) and occlusion of main vessels (2:2) were the method-related complications in the EV and S groups, respectively.


CONCLUSIONS
After comparing the literature data, acute interdisciplinary treatment of patients with SAH increases the rate of aneurysm occlusion, improves patient's evolution and reduces the number of complications.
Carvi Y Nievas
Mario Nazareno
MN
Department of Neurosurgery, Städtische Kliniken, Höchst, Frankfurt am Main, Germany. mcnievas@t-online.de
Hattingen
Joerg
J
Hoellerhage
Hans-Georg
HG
D000208:Acute Disease; D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000601:surgery; D002533:Cerebral Angiography; D003657:Decision Making; D006760:Hospitalization; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D010348:Patient Care Team; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome