Clinical outcomes of surgical clipping for intracranial aneurysms in patients with a Hunt and Hess grade 4 or 5

Yang Zhang; Xiaobo Zhu; Kun Hou; Jinchuan Zhao; Xianfeng Gao; Yang Sun; Wei Wang; Xiaona Zhang

doi:10.1590/0004-282X20160064

Arquivos de Neuro-Psiquiatria, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2016; 74(06): 478-481
DOI: 10.1590/0004-282X20160064

ARTICLES

Clinical outcomes of surgical clipping for intracranial aneurysms in patients with a Hunt and Hess grade 4 or 5

Desfechos clínicos da clipagem cirúrgica de aneurismas intracranianos de graus 4 e 5 segundo a escala de Hunt & Hess

Autor*innen

Yang Zhang

¹The First Affiliated Hospital of Jilin University, Department of Neurosurgery, Changchun, Jilin, China
Xiaobo Zhu

¹The First Affiliated Hospital of Jilin University, Department of Neurosurgery, Changchun, Jilin, China
Kun Hou

¹The First Affiliated Hospital of Jilin University, Department of Neurosurgery, Changchun, Jilin, China
Jinchuan Zhao

¹The First Affiliated Hospital of Jilin University, Department of Neurosurgery, Changchun, Jilin, China
Xianfeng Gao

¹The First Affiliated Hospital of Jilin University, Department of Neurosurgery, Changchun, Jilin, China
Yang Sun

¹The First Affiliated Hospital of Jilin University, Department of Neurosurgery, Changchun, Jilin, China
Wei Wang

¹The First Affiliated Hospital of Jilin University, Department of Neurosurgery, Changchun, Jilin, China
Xiaona Zhang

²The First Affiliated Hospital of Jilin University, Department of Anesthesiology, Changchun, Jilin, China.

Abstract

ABSTRACT

We retrospectively evaluated the records of 49 grade 4 and 5 patients with 42 intracranial aneurysms treated within 72 h of subarachnoid hemorrhage (SAH). In total, 35 patients (71%) were grade 4, and 14 (29%) were grade 5. A total of 42 (85%) patients had one aneurysm, 6 (12%) had two aneurysms, and 1 (3%) had three aneurysms. Out of 49 patients, one technical (2%) and one clinical (2%) complication occurred at surgery. Twenty-one (43%) patients recovered well, including 7 with postoperative hematoma requiring an immediate evacuation of a clot. Fourteen (29%) patients had hydrocephalus and required a ventriculo-peritoneal shunt; 12 patients underwent tracheotomy postoperatively due to coma and pulmonary infection. We found that patients with Hunt and Hess grade 4 and 5 aneurysms can undergo successful neurosurgical clipping of the aneurysms after SAH. However, the morbidity and mortality rates remain high because of their poor clinical condition and a high incidence of vasospasm during treatment.

RESUMO

Avaliamos retrospectivamente os registros de 49 pacientes com 42 aneurismas intracranianos de graus 4 e 5, tratados nas primeiras 72 horas após uma hemorragia subaracnóidea (HSA). Trinta e cinco pacientes (71%) apresentavam grau 4 e catorze (29%) grau 5. Quarenta e dois pacientes (85%) tinham um único aneurisma, seis (12%) tinham dois aneurismas, e um paciente (3%) tinha três aneurismas. Dos 49 pacientes, uma complicação técnica (2%) e uma complicação clínica (2%) ocorreram durante a cirurgia. Vinte e um pacientes (43%) recuperaram-se bem, incluindo sete que tiveram hematomas pós-operatórios que requereram a imediata evacuação do coágulo. Catorze pacientes (29%) tiveram hidrocefalia e submeteram-se à derivação ventrículo-peritoneal; doze pacientes submeteram-se à traqueostomia no pós-operatório, devido a coma e infecção pulmonar. Pacientes com aneurismas de graus 4 e 5, segundo a escala de Hunt & Hess podem submeter-se com sucesso à clipagem dos aneurismas após HSA. Entretanto, as taxas de morbidade e mortalidade ainda são altas, devido à condição clínica precária e à alta incidência de vasoespasmo durante o tratamento.

cerebral aneurysm - surgical instruments - subarachnoid hemorrhage

aneurisma cerebral - instrumentos cirúrgicos - hemorragia subaracnóidea

Volltext

Referenzen

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