Modulated surgery in the management of ruptured intracranial aneurysm in poor grade patients

Poor-Grade Ruptured Middle Cerebral Artery Aneurysm With Intracerebral Hematoma: Bleeding Characteristics and Management

“…Previous studies have shown that age and initial Glasgow Coma Scale (GCS) can predict outcomes, but none have validated the exclusion criteria for aggressive treatment in patients with high-grade SAH. 9,11,12,14,[18][19][20]22,25,26) The present study describes the anatomical and clinical findings during surgical treatment of poorgrade ruptured MCA aneurysms, and tailored surgical strategies based on the distribution of hematoma. The three study objectives are to identify patients with the worst neurological status prior to treatment who were able to achieve useful daily life; to follow functional outcomes and living status in patients who underwent aggressive treatment; and to describe the surgical procedures and how these were employed in our clinical practice.…”

“…1,3,9,12,15,26,27) Adequate treatment often requires hematoma evacuation and decompressive maneuvers in addition to clipping procedures. 4,7,16,21,23,24,26) However, there are few detailed descriptions of procedures that are appropriate for the management of poor-grade SAH with ruptured MCA aneurysm. Previous studies have shown that age and initial Glasgow Coma Scale (GCS) can predict outcomes, but none have validated the exclusion criteria for aggressive treatment in patients with high-grade SAH.…”

“…1,3,5,6,17,19,29,34) Patients do not always achieve outcomes consistent with their initial neurological status, and 50-60% of patients affected by rupture of an intracranial aneurysm can become functional survivors. 3,[9][10][11][12]14,18,20,22,25,26) However, insufficient surgical intervention may result in loss of potentially salvageable function or life. 1,3,9,12,15,26,27) Adequate treatment often requires hematoma evacuation and decompressive maneuvers in addition to clipping procedures.…”

“…3,[9][10][11][12]14,18,20,22,25,26) However, insufficient surgical intervention may result in loss of potentially salvageable function or life. 1,3,9,12,15,26,27) Adequate treatment often requires hematoma evacuation and decompressive maneuvers in addition to clipping procedures. 4,7,16,21,23,24,26) However, there are few detailed descriptions of procedures that are appropriate for the management of poor-grade SAH with ruptured MCA aneurysm.…”

One-stage embolization in patients with acutely ruptured poor-grade aneurysm

“…Moreover, bultra-earlyQ surgery is often recommended because a major risk of rebleeding after SAH is present within the first 6 to 12 hours, and the risk of ultra-early rebleeding is highest for poor-grade patients [15]. While early surgery decreases the risk of rehemorrhage, it is often questioned because of concerns related to increased risk of surgical complications and the infliction of further damage to the already edematous brain caused by retraction and manipulation of cerebral vessels [5,6,10,11,14,27,29].…”