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2015, Number 2

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Rev Cubana Neurol Neurocir 2015; 5 (2)

Surgical results of patients with aneurismatic subarachnoid hemorrhage treated by protocolized approach in “Hermanos Ameijeiras” Hospital

González GJL, Bretón RJL, Elizondo BL, López AO, Salva CSN, González LA, Pérez NJ, Scherle MCE, Rivero GM, Mora DI

Language: Spanish
References: 50
Page: 133-145
PDF size: 731.40 Kb.


ABSTRACT

Objective: To assess basal characteristics and surgical outcome in patients with aneurismatic subarachnoid hemorrhage managed with one dynamic protocol based mostly on transcranial Doppler ultrasound.
Methods: A descriptive longitudinal study was carried out in 233 patients with aneurismatic subarachnoid hemorrhages, who received neurosurgical clipping in the years 2006–2010 and were followed during one year.
Results: Mean age was 49.19 years. Female were 66 %. At the admission, 58.4 % of cases were in grade 1 according to the modified scale of World Federation of Neurosurgical Societies (WFNS). Preoperatively 69.5 % of patients become grade 1. Patients were mostly Fisher 3 according to CT scan results, and this was statistically associated with vasospasm. Angiographic vasospasm was present in 28.8 % of the cases, but increased to 49.4 % by using transcranial Doppler. In 25.8 % of cases vasospasm was symptomatic, and 15.9 % develop delayed ischemic deficit. Single aneurysms on the anterior Willis circle were most relevant statistically and accounted for 73.4 % of the cases. Aneurysms were mostly of relatively small size, and in 79.4 % of the patients they ranged between 4 and 10 mm. Outcome was favorable in 93 %, and mortality was 4.29 %. Outcome was significant associated with: neurological status at the admission, Fisher scale, numbers of aneurysms, vasospasm, and re–bleeding. Most frequents surgical and medical complications were vasospasm, re–bleeding, cerebral infarct urinary infection, hydrocephalus and intraoperative rupture.
Conclusions: Compared with several series from specialized literature, outcome in this series was good. These suggest the utility of one dynamic protocol based on transcranial Doppler in patients with aneurismatic subarachnoid hemorrhage.


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