Poor-grade subarachnoid hemorrhage: Is surgical clipping worthwhile?

Gupta, Sunil; Ghanta, Rajesh K; Chhabra, Rajesh; Mohindra, Sandeep; Mathuriya, S. N.; Mukherjee, Kanchan Kumar; Umredkar, Alok U; Singla, Navneet

doi:10.4103/0028-3886.79144

Cited by 24 publications

(21 citation statements)

References 33 publications

(69 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[1] Mortality reported with aneurysmal SAH (aSAH) is about 50% and furthermore, survivors of aSAH are left with high morbidity. [3,4] aSAH also pose risk for hypothalamo-pituitary dysfunctions as a result of proximity of hypothalmo-pituitary structure to the circle of Willis. Over the last few years, number of studies has been carried out to determine hypothalamo-pituitary dysfunction in survivor of aSAH.…”

Section: Endocrine Abnormalities Definitionsmentioning

confidence: 98%

Pituitary dysfunction in survivors of spontaneous subarachnoid hemorrhage of anterior communicating artery and middle cerebral artery aneurysms: A comparative study

et al. 2012

Self Cite

View full text Add to dashboard Cite

show abstract

Section: Endocrine Abnormalities Definitionsmentioning

confidence: 98%

Pituitary dysfunction in survivors of spontaneous subarachnoid hemorrhage of anterior communicating artery and middle cerebral artery aneurysms: A comparative study

et al. 2012

Self Cite

View full text Add to dashboard Cite

show abstract

“…In thousands of hundreds patients with aSAH, the poor-grade cases takes the proportion from 24% to 45%, and the clinical outcome of this population remains dismal (15). It is also reported that the re-bleeding rate is actually higher compared with good-grade (15).…”

Section: Poor Clinical Condition At Admissionmentioning

confidence: 99%

Surgical timing for aneurysmal subarachnoid hemorrhage: a meta-analysis and systematic review

Zhao

Yi²

2015

Turkish Neurosurgery

View full text Add to dashboard Cite

dent after surgery (19). Therefore, with the economic burdens of aSAH increasing every year, cost effectiveness and preventative strategies have become much more important.Before the 1970s, it was thought that cerebral edema and cerebral vascular dysregulation after acute aSAH, were associated with early surgery. In order to avoid the unfavorable █ INTRODUCTION A lthough intracranial aneurysmal subarachnoid hemorrhage (aSAH) accounts only for 3% to 4% of all strokes and 4.4% of deaths from stroke (18,50), aSAH is a significant health problem, which within 1 month has a mortality rate of nearly 50%, and many patients become care-depenAIm: Despite great advances in treatment of aneurysmal subarachnoid hemorrhage (aSAH), yet, a consensus as to the most optimal timing of surgery has not been reached. In order to identify the most suitable time of surgery for aSAH, the authors conducted a meta-analysis and systematic review. mATERIAl and mEThODS: PubMed and the Cochrane Library were searched for English-language studies published up to May 2015. Two independent reviewers screened abstracts, reviewed full-text articles and extracted data. Before conducting the metaanalysis, the studies were evaluated for publication bias and heterogeneity. Fixed and random effect models were used to estimate relative risks (RR) and the corresponding 95% confidence intervals (CIs). Subgroup analysis and sensitivity analysis were also performed. RESUlTS:One randomized controlled trial (RCT) and 33 observational studies of 16,793 participants were included in this paper. The overall methodological quality was satisfying. Results after excluding articles inconsistent with our surgery timing definition showed no significant difference for poor outcome, with early vs intermediate treatment (RR 0.86[0.68,1.09]), early vs late (RR 0.99[0.70,1.40]). Subgroup analysis based on age showed that early surgery could obtain more favorable outcomes for death rate, with non-early group as reference when age ≥50 years (RR 0.52[0.29,0.93]). When less than 50 years old, patients could benefit more from early intervention for poor outcome, with intermediate group as reference (RR 0.18[0.04,0.78 ]).CONClUSION: Despite the shortcomings of this study, timing of surgery for aSAH did not put a significant impact on overall surgical outcome. But subgroup analysis indicated a trend with more benefits for early treatment. Given the risks of re-bleeding and inpatient stay, early intervention should be performed as soon as possible. However, more randomized trials with long-term followup are necessary, especially in this era of endovascular coiling.

show abstract

“…Early surgery should be carried out as soon as the patient's condition allows. In fact, a recent study (5) has determined that early intervention reduces re-bleeding and control vasospasm, thus significantly improving a patient's long-term survival. Early treatment of an aneurysm is the most effective means to prevent re-bleeding and "triple-H" (hypertension, hypervolemia, and hemodilution).…”

Section: Tan H Et Al: Surgical Timing Of Aneurysms With Acute Hydrocmentioning

confidence: 99%

The impact of surgical timing on the management of aneurysms with acute hydrocephalus after aneurysmal subarachnoid hemorrhage

Tan¹,

Huang²,

Li³

et al. 2014

Turkish Neurosurgery

View full text Add to dashboard Cite

AIm:To explore the feasibility and effectiveness of early microsurgical therapy for acute hydrocephalus resulting from a ruptured intracranial aneurysm. mATERIAL and mETHods: Forty patients with Hunt-Hess grades II-III were assigned to group A; 27 patients with grades IV-V formed group B. The patients were also divided into 2 groups based on the time interval between the hemorrhage and surgery. Subjects in the early surgery group underwent aneurysm clipping within 3 days of subarachnoid hemorrhage (SAH), followed by intraoperative lateral ventricle puncture and third ventriculostomy. Subjects in the late surgery group underwent aneurysm clipping within 10 days of SAH, after initial treatment with lateral ventricular drainage. Three months after surgery, we used the Glasgow Outcome Scale (GOS) to compare the differences between the early and late surgery groups.REsuLTs: More patients benefited from early surgery than from late surgery in both groups: GOS4-5 was achieved by 75% and 73.3% of early-surgery patients compared to 37.5% and 25% of late-surgery patients from Groups A and B, respectively (both p <0.05). Analysis of the relationship between surgical timing and outcomes with the Ridit method showed that outcomes of early surgery were better than those of late surgery (p <0.05).CoNCLusIoN: Aneurysmal SAH with acute hydrocephalus requires early surgery.KEywoRds: Hydrocephalus, Intracranial aneurysm, Subarachnoid hemorrhage, Surgical timing ÖZ AmAÇ: Rüptüre intrakranial anevrizmadan kaynaklanan akut hidrosefalinin erken mikrocerrahi tedavisinin uygulanabilirliğini ve etkinliğini araştırmak. yÖNTEm ve GEREÇLER: Hunt-Hess derece II-III olan kırk hasta A grubuna atandı ve derece IV-V olan 27 hasta B grubunu oluşturdu. Hastalar aynı zamanda kanama ve ameliyat arasındaki zaman aralığına dayanarak 2 gruba ayrıldılar. Erken cerrahi grubundaki hastalara intraoperatif lateral ventrikül ponksiyonu ve üçüncü ventrikülostomiyi takiben subaraknoid kanamadan sonraki 3 gün içerisinde anevrizma kliplenmesi yapıldı. Geç cerrahi grubundaki hastalara lateral ventrikül drenajı ile ilk tedaviyi takiben, subaraknoid kanamadan sonraki 10 gün içinde anevrizma kliplenmesi yapıldı. Ameliyattan üç ay sonra, erken ve geç cerrahi gruplar arasındaki farklılıkları değerlendirmek için Glasgow Sonuç Ölçeğini (GSÖ) kullanıldı.BuLGuLAR: Her iki grupta da geç cerrahiye nazaran daha fazla hasta erken cerrahiden yararlanmıştır: A ve B grupları için sırasıyla, erken ameliyat olan hastalarda %75 ve %73,3 ve geç hastalarda %37,5 ve %25 oranlarında GSÖ 4-5 değerlerine ulaşıldı (ikisi için de p <0.05). Ridit yöntemi ile cerrahi zamanlama ve sonuçları arasındaki ilişkinin analizi erken cerrahinin sonuçlarının geç cerrahininkinden daha iyi olduğunu gösterdi (p <0,05).soNuÇ: Akut hidrosefali ile anevrizmal subaraknoid kanama erken ameliyat gerektirir.

show abstract

Poor-grade subarachnoid hemorrhage: Is surgical clipping worthwhile?

Cited by 24 publications

References 33 publications

Pituitary dysfunction in survivors of spontaneous subarachnoid hemorrhage of anterior communicating artery and middle cerebral artery aneurysms: A comparative study

Pituitary dysfunction in survivors of spontaneous subarachnoid hemorrhage of anterior communicating artery and middle cerebral artery aneurysms: A comparative study

Surgical timing for aneurysmal subarachnoid hemorrhage: a meta-analysis and systematic review

The impact of surgical timing on the management of aneurysms with acute hydrocephalus after aneurysmal subarachnoid hemorrhage

Contact Info

Product

Resources

About