The influence of angiospasm on the results of microsurgical treatment of cerebral arterial aneurysms in the acute period of rupture
Keywords:angiospasm, brain arterial aneurysms, cerebral ischemia, microsurgical treatment
The purpose of the study was to study the effect of angiospasm on the results of microsurgical treatment of arterial aneurysms (AA) in the brain in the acute rupture period.
Material and methods. A retrospective analysis of 332 case histories of patients with brain AA treated in Mechnikov Dnipropetrovsk Regional Hospital from 2013 to 2018 was performed. All patients were admitted in the acute period of AA rupture, from one to 15 days from the onset of the disease. All patients were divided into 5 groups, depending on the timing of the operation. The group I enrolled 54 patients. They were operated within the first 3 days after the AA rupture. Group II included 56 patients. They were operated in the most unfavorable terms — from 4 to 8 days from the onset of the disease. Group III consisted of 106 patients operated on the 9–14th day from the onset of the disease. Group IV included 103 patients who were operated on the 15–30th day from the onset of the disease. Group V consisted of 13 patients who were operated within more than 30 days after the rupture of AA. In addition to general and biochemical blood tests, all patients underwent spiral computed tomography, cerebral angiography, transcranial dopplerography. The severity of the initial condition was evaluated on a Hunt-Hess scale; the treatment results were assessed on Glasgow Outcome Scale.
Results. A clear dependence of treatment results on the severity and prevalence of angiospasm was revealed. When operating in AS grade III, the Glasgow Outcome Scale described the outcome as 4 or 5 scores. Only 4 patients with AS grade II demonstrated relatively decentish results. The patients operated against the background of AS grade I or without AS developed good results. The patients with AS grade II or III demonstrated substantively worse outcomes (p = 0.004174). The lethality was double-fold lower in group 2 compared to group 1; no vegetative state was determined. In group 3, the lethality level was 10.4 % and was slightly lower compared to group 2. In group 4, the lethality level was 7.8 %. No lethal outcome was registered in group 5.
Conclusions. The severity and prevalence of angiospasm in aneurysmal SAH are strictly individual. Angiospasm does not always cause cerebral ischemia, but the presence of brain ischemia on SCT always indicates the angiospasm. The results of the microsurgical treatment of AA are statistically significantly worse in patients who were operated against the background of angiospasm of the second and third degrees.
1. Krylov VV., editor. [Microsurgery of cerebral aneurysms]. Moscow: 2011. Russian.
2. Krylov VV, Kalinkin AA, Petrikov SS. [The pathogenesis of cerebral angiospasm and brain ischemia in patients with non-traumatic subarachnoid hemorrhage due to cerebral aneurysm rupture]. Neurological journal. 2014;19(5):4-12. Russian. https://www.elibrary.ru/item.asp?id=22024290
3. Reykhert LI, Ostapchuk ES, Skorikova VG. [Cerebral vasospasm and its effect on outcomes in patients with aneurismal subarachnoid hemmorrhage]. Medical science and education of Urals. 2014;15:2(78):64-68. Russian. https://www.elibrary.ru/item.asp?id=22580623
5. Budohoski KP, Guilfoyle M, Helmy A, Huuskonen T, Czosnyka M, Kirollos R, Menon DK, Pickard JD, Kirkpatrick PJ. The pathophysiology and treatment of delayed cerebral ischaemia following subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry. 2014 Dec;85(12):1343-53. [CrossRef] [PubMed]
6. Flynn L, Andrews P. Advances in the understanding of delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage. F1000Res. 2015 Nov 2;4:F1000 Faculty Rev-1200. [CrossRef] [PubMed] [PubMed Central]
7. Kozlov SY, Rodionov SV, Rudnev MA. [Prognostic factors of surgical treatment of arterial aneurysms of the brain]. Vestnik novyh medicinskih tehnologij. 2012;19(2):153-7. Russian. https://elibrary.ru/item.asp?id=17878921
8. Lytvak SO. [Individualization of microsurgical tactics during clipping cerebral arterial aneurysms]. Endovascular Neuroradiology. 2018 Dec 27;24(2):52-68. Ukrainian. [CrossRef]
9. Steiner T, Juvela S, Unterberg A, Jung C, Forsting M, Rinkel G; European Stroke Organization. European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis. 2013;35(2):93-112. [CrossRef] [PubMed]
10. Krylov VV, Dash’yan VG, Shatokhin TA, Sharifullin FA, Solodov AA, Prirodov AV, Levchenko OV, Tokarev AS, Khamidova LT, Kuksova NS, Ayrapetyan AA, Kalinkin AA. [The timing of open surgical treatment for patients with massive basal subarachnoid hemorrhage (Fisher 3) because of cerebral aneurysms rupture]. Russian Journal of Neurosurgery. 2015(3):11-7. Russian. https://www.therjn.com/jour/article/view/193/194
11. Dhar R, Scalfani MT, Blackburn S, Zazulia AR, Videen T, Diringer M. Relationship between angiographic vasospasm and regional hypoperfusion in aneurysmal subarachnoid hemorrhage. Stroke. 2012 Jul;43(7):1788-94. [CrossRef] [PubMed] [PubMed Central]
15. Malinova V, Dolatowski K, Schramm P, Moerer O, Rohde V, Mielke D. Early whole-brain CT perfusion for detection of patients at risk for delayed cerebral ischemia after subarachnoid hemorrhage. J Neurosurg. 2016 Jul;125(1):128-36. [CrossRef] [PubMed]
16. Alabbas F, Hadhiah K, Al-Jehani H, Al-Qahtani SY. Hyponatremia as predictor of symptomatic vasospasm in aneurysmal subarachnoid hemorrhage. Interdisciplinary Neurosurgery. 2020 Jul 28:100843. [CrossRef]
17. Krylov VV, Gusev SA, Titova GP, Gusev AS. [Vascular spasm after subarachnoid hemorrhage. Clinical atlas]. Moscow: Maktsentr. 2000. Russian. https://elibrary.ru/item.asp?id=25499951
18. Kumar G, Shahripour RB, Harrigan MR. Vasospasm on transcranial Doppler is predictive of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. J Neurosurg. 2016 May;124(5):1257-64. [CrossRef] [PubMed]
19. Tsimeyko OA, Moroz VV. [Vasospasm in subarachnoid haemorrage after arterial aneurysm’s rupture: ethiology, pathogenesis (Review of literature)]. Ukrainian Neurosurgical Journal. 2002;(2):22-8. Ukrainian. http://theunj.org/article/view/91808
20. Chekanova OV, Skryabin VV. [Optimization of clinical-instrumental diagnosis of cerebral angiospasm in aneurysmal subarachnoidal bleeding]. Sibirskij medicinskij žurnal (Tomsk). 2008;23(4-2):71-5. Russian. https://elibrary.ru/item.asp?id=13043534
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