The influence of angiospasm on the results of microsurgical treatment of cerebral arterial aneurysms in the acute period of rupture

Abstract

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.