Dehdashti Amir R, Mermillod Bernadette, Rufenacht Daniel A, Reverdin Alain, de Tribolet Nicolas
Department of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland.
Cerebrovasc Dis. 2004;17(1):53-60. doi: 10.1159/000073898. Epub 2003 Oct 3.
Cerebral vasospasm is the most common cause of morbidity and mortality after aneurysmal subarachnoid hemorrhage (SAH). This study is designed to determine whether the incidence of symptomatic vasospasm and the overall clinical outcome differ between patients treated with surgical clipping compared with endovascular obliteration of aneurysms.
In this prospective study, 98 patients with aneurysmal SAH were treated. Seventy-two patients underwent surgery and clipping and 26 had coil embolization. The incidence of symptomatic vasospasm, permanent neurologic deficit due to vasospasm and clinical outcome were analyzed. Patients with better clinical and radiological grades (World Federation of Neurological Surgeons grades I-III and Fisher grades I-III) were analyzed separately.
Symptomatic vasospasm occurred in 22% of the patients; 25% in the surgical group and 15% in the endovascular group. Nine percent of the patients in the surgical group and 7% in the endovascular group suffered ischemic infarction with permanent neurological deficit. These differences did not reach statistical significance (p = 0.42). For patients with better clinical and radiological grades, no significant difference was found for the rate of symptomatic vasospasm; 23% in the surgical and 12% in the endovascular group (p = 0.49). The overall clinical outcome was comparable in both groups, with no difference in the likelihood of a Glasgow Outcome Scale score of 3 or less (15% in the surgical and 16% in the endovascular group; p = 0.87). The same results for outcome were obtained for the subgroup of patients with better clinical grades on admission.
Symptomatic vasospasm and ischemic infarction rate seem comparable in both groups, even for patients with better clinical and radiological admission grades. There is no significant difference in the overall clinical outcome at the long-term follow-up between both groups.
脑血管痉挛是动脉瘤性蛛网膜下腔出血（SAH）后发病和死亡的最常见原因。本研究旨在确定与动脉瘤血管内栓塞治疗相比，手术夹闭治疗的患者中症状性血管痉挛的发生率和总体临床结局是否存在差异。
在这项前瞻性研究中，对98例动脉瘤性SAH患者进行了治疗。72例患者接受了手术夹闭，26例进行了弹簧圈栓塞。分析了症状性血管痉挛的发生率、因血管痉挛导致的永久性神经功能缺损和临床结局。对临床和放射学分级较好（世界神经外科联合会分级I-III级和Fisher分级I-III级）的患者进行了单独分析。
22%的患者发生了症状性血管痉挛；手术组为25%，血管内治疗组为15%。手术组9%的患者和血管内治疗组7%的患者发生了伴有永久性神经功能缺损的缺血性梗死。这些差异未达到统计学意义（p = 0.42）。对于临床和放射学分级较好的患者，症状性血管痉挛的发生率没有显著差异；手术组为23%，血管内治疗组为12%（p = 0.49）。两组的总体临床结局相当，格拉斯哥预后量表评分为3分及以下的可能性没有差异（手术组为15%，血管内治疗组为16%；p = 0.87）。入院时临床分级较好的患者亚组也得到了相同的结局结果。
即使是临床和放射学入院分级较好的患者，两组的症状性血管痉挛和缺血性梗死发生率似乎也相当。两组在长期随访中的总体临床结局没有显著差异。
