[Results of treatment of subarachnoid haemorrhage due to a ruptured cerebral aneurysm].

OBJECTIVE

This study was designed to evaluate patients with confirmed aneurismal SAH (subarachnoid haemorrhage) in Leo n Hospital between 2001 and 2003.

MATERIALS AND METHODS

The treatment protocol includes: rapid transfer to the reference centre, blood pressure control and nimodipine infusion, arteriography and endovascular treatment within the first 72 hours after admission. Surgery is performed as soon as possible if embolization is not possible. Aggressive antiaeschemic handling and transcranial Doppler are used for diagnosis and vasospasm monitoring. The patients were classified on admission according to the Hunt-Hess scale. Monitoring continued until discharge, and morbidity (any degree of neurological deficiency on discharge, not paralysis of a cranial pair) and mortality were analysed. P< 0.05 was considered statistically significant.

RESULTS

During the study period 54 patients had SAH on admission, 86% of whom were admitted to Intensive Care Unit 24 hours after bleeding. Five patients were not treated as they had massive SAH with Hunt-Hess V. Four of them died . Of the remaining 49 patients (90.74%) embolization was successful in 28 (54% ) but 21 (38%) were not embolized due to the characteristics of the aneurysm; they were operated on within the following 72 hours. Six embolized 16.8%) and 3 (14.2%) patients operated on had neurological sequelae (p> 0.05). Three endovascularly treated patients (14.2%) and 4 (19%) surgically treated died (p>0.05 ). The frequency of clinical vasospasm was 20% an rebleeding occurred in 16%. The length of stay in the ICU of embolized patients was significantly shorter than the operated patients (6.1 vs 8.8 )days, p<0.05.

CONCLUSION

The endovascular treatment can be successfully carried out in over half of the patients with ruptured aneurysms. There is a significant relationship between the degree of consciousness on admission and the prognosis. We found no statistically significant differences in morbid-mortality between the embolized patients and those undergoing conventional surgery. However, there was a difference in length of stay in the ICU (shorter in patients treated by endovascular coiling).