title: [Effect of aneurysm clipping on hemorrhage volume in the subarachnoid space].
abstract: OBJECTIVE
  To evaluate the effect of aneurysm clipping and partial blood clot removal in the subarachnoid space on hemorrhage volume in the subarachnoid space and cerebral vasospasm in patients with different Fisher grades.
  
  
  METHODS
  Patients with subarachnoid space hemorrhage (SAH) of Fisher Grades I, II, and III were subdivided into control and treatment groups for comparative studies. The patients with unruptured intracranial aneurysms (UIAs) undergoing aneurysm clipping were also compared with Fisher grade I control subgroup. OxyHb levels in the cerebrospinal fluid and cerebral blood flow volume (CBFV) of the middle cerebral artery (MCA) were measured on days 3, 7, and 13 day after SAH.
  
  
  RESULTS
  The patients with UIAs and Fisher Grade I control subgroup showed significant differences in OxyHb levels on day 3 in CBFV of the MCA on days 3 and 7 (P<0.05). In the SAH groups, OxyHb levels increased significantly on day 3 day in the treatment subgroups of Fisher Grades I and II, but declined significantly on days 7 and 13 in Fisher Grade III treatment subgroup as compared with the corresponding control subgroups (P<0.05); in Fisher Grade I group on days 3 and 7 and in Fisher Grade II group on day 7, CBFV of the MCA increased significantly in the treatment subgroups, but in Fisher Grade III group, CBFV decreased significantly on days 7 and 13 compared with the control subgroup (P<0.05). A positive correlation was found between OxyHb levels in the cerebrospinal fluid and CBFV of the MCA (P<0.05).
  
  
  CONCLUSIONS
  For patients with Fisher Grades I and II aneurysms, craniotomy may increase hemorrhage volume in the subarachnoid space and exacerbate cerebral vasospasm, but for Grade III patients, aneurysm clipping and blood clot removal shows beneficial effects in terms of reducing hemorrhage volume and relieving cerebral vasospasm.
authors.affiliation: Department of Neurosurgery, Third Xiangya Hospital of Central South University, Changsha, China. doctorlf@126.com
authors.forename: Fei
authors.initials: F
authors.lastname: Liu
authors.forename: Wen
authors.initials: W
authors.lastname: Yuan
authors.forename: Daguang
authors.initials: D
authors.lastname: Liao
authors.forename: Tianyi
authors.initials: T
authors.lastname: Zhang
authors.forename: Zhifei
authors.initials: Z
authors.lastname: Wang
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000601:surgery; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000134:cerebrospinal fluid* / Q000601:surgery*; D020301:Vasospasm, Intracranial / Q000601:surgery