Removal of clots in subarachnoid space could reduce the vasospasm after subarachnoid hemorrhage.
BACKGROUND
Cerebral vasospasm after subarachnoid hemorrhage (SAH) is a major cause of morbidity and mortality. We studied the effects of clot removal on multiple outcome variables following the clipping of ruptured anterior communicating aneurysms.


METHODS
From 2007 to 2011, 30 patients with Fisher grade III aneurysmal SAH underwent clipping of an anterior communicating artery aneurysm before SAH day 3. There were 20 women and 10 men, mean age 53.4, range 28-80 years. Seventeen underwent fenestration of lamina terminalis and cisternal removal of clots (group A), and 13 did not (Group B). We compared clinical grades, presence of hydrocephalus at admission, treatment modality, occurrence of clinical vasospasm, the need for interventional vasospasm therapy, and need for ventriculoperitoneal shunting.


RESULTS
Vasospasm affected 5 of 17 (29%) in group A and 8 of 13 (61.5%) in group B (p < 0.05). Endovascular treatment for vasospasm was required in one patient in group A (5.8% of 17, 20% of 5) and in five from group B (38.4% of 13, 62.5% of 8) (p < 0.05). Mortality was observed in one case in group A (5.8% of 17, 20% of 5) and in two cases in group B (15.3% of 13, 25% of 8) and was related to vasospasm after SAH. Ventriculoperitonal shunt (VPS) was required in one case in group A (5.8%) and in five cases in group B (38.4%).


CONCLUSIONS
Fenestration of the lamina terminalis and removal of cisternal clots significantly decreased the incidence of post-SAH hydrocephalus and was associated with better outcomes in our series.
Department of Neurology, Santa Paula Hospital, São Paulo, Brazil. phapaneurocir@gmail.com
Paulo H Pires
PH
de Aguiar
Icaro
I
Barros
Bernardo L
BL
Paiva
Renata F
RF
Simm
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007031:Hypothalamus / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000601:surgery*; D013346:Subarachnoid Space / Q000601:surgery*; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000209:etiology / Q000517:prevention & control*; D017287:Ventriculoperitoneal Shunt / Q000379:methods*