Effect of lumbar puncture in patients with aneurysmal subarachnoid hemorrhage treated microsurgically or endovascularly.
OBJECTIVE
The aim of this study was to evaluate the effect of treatment modality (surgical clipping vs. endovascular coiling) and lumbar puncture (LP) in patients with aneurysmal subarachnoid hemorrhage (SAH) based on neurologic status on admission and clinical outcome.


METHODS
One hundred forty-eight consecutive patients with ruptured intracranial aneurysms treated via endovascular or surgical methods were included in our study. Patients who refused further therapy or received only supportive therapy because of bad neurologic status were excluded. Severity of SAH was evaluated using the Fisher score. World Federation of Neurosurgical Societies (WFNS) and Hunt and Hess (H&H) scores were used for evaluation of neurologic status. Glasgow Outcome Scale scores and modified Rankin scores were used for outcome evaluation.


RESULTS
We found that modified Rankin scores were significantly lower in the surgical clipping group (1.1 ± 1.4) than in the endovascular coiling group (1.7 ± 1.8) (p: 0.04). The positive lumbar puncture [LP(+)] group had similar outcome scores as the negative lumbar puncture [LP(-)] group, although the LP(+) group had worse initial SAH evaluation scores (WFNS 1.64 ± 0.95-1.23 ± 0.61, p: 0.0004 and H&H 2.18 ± 1.07-1.65 ± 0.88, p: 0.001).


CONCLUSIONS
Surgical clipping might improve clinical outcome better than endovascular coiling, although a more confident conclusion requires absolute randomization of patients for both treatments. LP could also improve clinical outcome in patients with high initial SAH evaluation scores.
Department of Anesthesiology and Intensive Care, Istanbul University, Istanbul, Turkey. iozkana@yahoo.com
Ibrahim O
IO
Akinci
A
A
Sencer
A
A
Basel
Y
Y
Aras
A
A
Aydoseli
C
C
Kamar
E
E
Güresti
S
S
Sencer
K
K
Aydın
N
N
Izgi
Talat
T
Kiris
D000328:Adult; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D013129:Spinal Puncture / Q000379:methods*; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis* / Q000601:surgery*; D016896:Treatment Outcome