D'Andrea Giancarlo, Picotti Veronica, Familiari Pietro, Barbaranelli Claudio, Frati Alessandro, Raco Antonino
F. Spaziani Hospital, Neurosurgery, Frosinone, Italy.
F. Spaziani Hospital, Neurosurgery, Frosinone, Italy; S. Andrea Hospital, Neurosurgery, University of Rome "La Sapienza", Roma, Italy.
Clin Neurol Neurosurg. 2020 May;192:105714. doi: 10.1016/j.clineuro.2020.105714. Epub 2020 Feb 3.
Timing of surgical treatment of ruptured intracranial aneurysms has undergone a drastic change in the last few decades with preference for early surgery Our paper focuses specifically on the prognostic importance of timing of surgery, since early surgery of ruptured aneurysms provides immediately good clinical results. We present a series of cases operated in early and ultra early surgery, evaluating the technical aspects, the efficacy, the safety and the clinical results.
We retrospectively reviewed the clinical records and radiological imaging of patients treated for ruptured intracranial aneurysms who underwent early and ultra early clipping between January 2011 and April 2017 at our Institution. We included patients treated within the first 12 h and subsequently we divided our series in two subgroups based on the timing of surgery comparing the "early surgery" group (within 12 h) with the "ultra early surgery" group (within 6 h).
Seventy-six (76) patients undergoing either early or ultra-early surgery for ruptured intracranial aneurysms have been reported Either early or ultra-early surgery showed a statistically favorable impact on reducing the incidence of both postoperative vasospasm and hydrocephalus. Ultra-early surgery group had the best outcome at the statistical analyses. (good postoperative 1Y GOSE.) CONCLUSIONS: We strongly believe that patients affected by ruptured intracranial aneurysms excluding Hunt and Hess grade V patients) should be treated as soon as possible and hence it should be considered as an emergency surgery. This approach prevents immediately a second bleeding of the aneurysm, allows to treat any associated condition of intracranial hypertension including hematomas and hydrocephalus and to use safely aggressive medical therapy such as hypertension.
在过去几十年中，颅内破裂动脉瘤的手术治疗时机发生了巨大变化，目前更倾向于早期手术。我们的论文特别关注手术时机的预后重要性，因为破裂动脉瘤的早期手术能立即带来良好的临床效果。我们展示了一系列早期和超早期手术的病例，评估了技术方面、疗效、安全性和临床结果。
我们回顾性分析了2011年1月至2017年4月在我院接受早期和超早期夹闭术治疗的颅内破裂动脉瘤患者的临床记录和影像学资料。我们纳入了在发病后12小时内接受治疗的患者，随后根据手术时机将我们的病例系列分为两个亚组，比较“早期手术”组（12小时内）和“超早期手术”组（6小时内）。
报告了76例接受颅内破裂动脉瘤早期或超早期手术的患者。早期或超早期手术在降低术后血管痉挛和脑积水的发生率方面均显示出统计学上的有利影响。在统计分析中，超早期手术组的结果最佳。（术后1年格拉斯哥预后量表评分良好。）结论：我们坚信，除Hunt和Hess分级为V级的患者外，颅内破裂动脉瘤患者应尽早接受治疗，因此应将其视为急诊手术。这种方法能立即防止动脉瘤再次出血，允许治疗任何相关的颅内高压情况，包括血肿和脑积水，并能安全地使用积极的药物治疗，如高血压治疗。
