Clinical and neuroimaging predictors of the outcome of microsurgical intervention against the background of cerebral aneurysms rupture

Abstract

Objective: minimization of the risks of complications of microsurgical intervention (MI) for cerebral aneurysm (CA) rupture due to established clinical and neuroimaging predictors. Material and methods. Evaluation of microsurgical treatment of 418 patients in the acute period of cerebral aneurysms (CA) rupture in the 2013-2018 period, that were operated at the Vascular Neurosurgery Center of the Dnipropetrovsk Regional Clinical Hospital named after I.I. Mechnikov, taking into account factors that may have an influence on favorable or unfavorable functional consequences. Age, gender, as well as clinical-neurological and neuroimaging assessment of the condition of patients according to the severity of aneurysmal subarachnoid hemorrhage (SAH) according to the Hunt-Hess classification, WFNS, level of consciousness impairment according to the Glasgow Coma Scale (GCS) were studied. The severity of aneurysmal subarachnoid hemorrhage was evaluated according to the Fisher prognostic scale according to the performed spiral computed tomography (SCT). Cerebral angiospasm (CAS) was evaluated according to cerebral angiography (CAG), and its severity according to transcranial dopplerography (TCD) on the day of hospitalization and surgery. The performed microsurgical intervention (MI) was evaluated according to the Glasgow Outcome Scale (GOS). The study was both retrospective and prospective. Results. Among 77 (18.4%) patients with adverse consequences of MI according to 1-3 points of GOS, a dependence was reliably found on the level of consciousness disturbance according to GCS, the severity of meningeal and focal symptoms, the severity of parenchymal hemorrhage, CAS manifestations on the day of surgery according to TCD, the duration of surgery after the rupture of CA (p<0.001). There was no statistically significant relationship between age, sex, localization, form and side of CA rupture. Also, a strong inverse correlation was found between GCS and classification of SAH according to WFNS rs=‒0.96 (95% CI 0.96-0.97) and Hunt-Hess rs=‒0.81 (95% CI 0.77-0.84) during hospitalization. Conclusions. The effectiveness of MI in the case of CA rupture depends on the severity of prognostic criteria of clinical and neurological examination - evaluation by the GCS, neurological disorders, severity of parenchymal hemorrhage, manifestations of CAS on the day of surgery for TCD, the duration of surgery after CA rupture. Revealed relationship between the score according to the GOS, classifications of SAH according to the WFNS and Hunt-Hess significantly simplifies diagnostic measures during the examination of patients in the acute period of CA rupture.