Comparison of surgical or endovascular treated aneurismal SAH patients with a special emphasis on cerebral vasospasm

Introduction

The aim of this study was to evaluate the incidence of delayed cerebral ischemia (DCI) and outcome in SAH patients who were admitted for surgical or endovascular procedures to treat cerebral aneurysm.

Methods

One hundred consecutive patients were evaluated according to their demographic data, severity of illness on admission, incidence of DCI, outcome and choice of treatment. The t test, Mann-Whitney U, and chi-square tests were used for statistical evaluation.

Results

Patients' demographic data were as shown in Table 1. Clinical vasospasm diagnosis was made by the existence of three signs which are headache, neurological deficit, and worsening of Glasgow Coma Score (GCS). Due to this evaluation 28 of the patients demonstrated DCI. While 14 of them were in the clipping group (23.3%), the other 14 were in the coiling group (35%). But HHH therapy and CSF drainage with lumber puncture was started more liberally, in 57 and 35 patients respectively, due to at least two of the following findings or clinician's decision: headache, agitation, elevated leukocyte level (without infection), new motor deficit and worsening in GCS. The severity of cases on admission in the clipping and coiling groups were similar for both. Although mortality and morbidity rates were higher in the coiling group there was no statistical difference in both groups (Table 2).

Table 1 Demographic data

Table 2

Conclusions

This study demonstrated that although mortality, morbidity rates and DCI incidence were lower in the surgical group, there was no statistical significance.