Salaud Céline, Hamel Olivier, Riem Tanguy, Desal Hubert, Buffenoir Kevin
Department of Neurosurgery, University of Nantes Medical Center, Nantes, France
Department of Neurosurgery, University of Nantes Medical Center, Nantes, France.
Interv Neuroradiol. 2016 Feb;22(1):5-11. doi: 10.1177/1591019915617320. Epub 2015 Dec 2.
Aneurysmal subarachnoid haemorrhage (ASH) with intracerebral hematoma (ICH) has a poor prognosis. The treatment is to secure the aneurysm and do an ICH evacuation.
The aim of the study was to determine if aneurysm coiling followed by ICH evacuation is a viable alternative treatment compared to exclusive surgery, regardless of the clinical or paraclinical presentations.
A retrospective study was conducted between 2004 and 2014, which included 44 patients. The patients were divided up in four groups. Two were principal groups: The clipped group (aneurysm clipping with ICH evacuation) and the coiled group (aneurysm coiling, followed by ICH evacuation); and two were subgroups of the latter: Aneurysm coiling with ICH evacuation after 24 hours and ICH evacuation followed by aneurysm coiling. We studied the demographic and radiologic characteristics, and the 3-month outcome.
We included 17 patients in the coiled group: The outcome was better for the patients with World Federation of Neurosurgery (WFNS) scores of 1, 2 and 3; compared to the patients with WFNS scores 4 and 5. We included 16 patients in the clipped group: The outcome was better, compared the coiled group, for those patients with WFNS scores 4 and 5. Six patients were treated with aneurysm coiling, followed by ICH evacuation after 24 hours: 33% had a good outcome. Five patients were treated by ICH evacuation, followed by aneurysm coiling: None had a good outcome.
It was necessary to realise a prospective study to compare the outcomes of patients with WFNS scores of 1, 2 or 3; between those with aneurysm coiling followed by ICH evacuation and aneurysm clipping with ICH evacuation, to determine the potential of using the coiling first, for these patients.
伴有脑内血肿（ICH）的动脉瘤性蛛网膜下腔出血（ASH）预后较差。治疗方法是确保动脉瘤安全并进行脑内血肿清除。
本研究的目的是确定与单纯手术相比，先行动脉瘤栓塞再行脑内血肿清除是否是一种可行的替代治疗方法，无论临床表现或辅助检查结果如何。
对2004年至2014年间的44例患者进行了回顾性研究。患者分为四组。两组为主组：夹闭组（动脉瘤夹闭并清除脑内血肿）和栓塞组（动脉瘤栓塞，随后清除脑内血肿）；后一组又分为两个亚组：24小时后行动脉瘤栓塞并清除脑内血肿组和先行脑内血肿清除再行动脉瘤栓塞组。我们研究了人口统计学和影像学特征以及3个月的预后情况。
栓塞组纳入17例患者：世界神经外科联合会（WFNS）评分为1、2和3的患者预后较好；与WFNS评分为4和5的患者相比。夹闭组纳入16例患者：与栓塞组相比，WFNS评分为4和5的患者预后较好。6例患者先行动脉瘤栓塞，24小时后再行脑内血肿清除：33%的患者预后良好。5例患者先行脑内血肿清除，再行动脉瘤栓塞：无一例预后良好。
有必要进行一项前瞻性研究，比较WFNS评分为1、2或3的患者，先行动脉瘤栓塞再行脑内血肿清除与动脉瘤夹闭并清除脑内血肿的患者的预后情况，以确定对这些患者优先使用栓塞治疗的可能性。
