Alhaj Ahmad Kh, Yousef Waleed, Alanezi Abdulrahman, Almutawa Mariam, Zaidan Salem, Alsheikh Tarik M, Abdulghaffar Moussa, Al-Saadi Tariq, Cavallo Luigi M, Savic Dragan
Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada.
Department of Neurosurgery, Ibn Sina Hospital, Ministry of Health, Kuwait City, Kuwait.
Surg Neurol Int. 2021 Nov 2;12:547. doi: 10.25259/SNI_914_2021. eCollection 2021.
Failure to prevent rebleeding after cerebral subarachnoid hemorrhage (SAH) is the most frequent reason for high morbidity and mortality of aneurysmal SAH. Our study aims to identify the outcome after surgical clipping of aneurysmal SAH before and after the establishment of the neurovascular unit. The clarifications of the positive turnover in the outcome will be discussed.
A retrospective cohort analysis was carried out on our experience with a controlled group of patients who underwent clipping for ruptured cerebral aneurysms ( = 61) from January 2015 to December 2019. A modified Rankin scale (mRS) was used to determine the outcome after 6 months of follow-up.
The median mRS score (i.e., outcome) on admission was 4, whereas it was with a median score of 2 six months after clipping ( ≤ 0.001). Overall, the cases with a good outcome were 63.9% of the sample, while the poor outcome conditions were 36.1%. The most cases with an improved outcome were after introducing the neurovascular unit, representing a transition of aneurysmal clipping practice in our center. The good outcome was changed from 42% to 76.7%, and the poor outcome was changed from 58% to 23.3% ( = 0.019). The crude mortality rate was similar to the rate worldwide (18%), with a noticeable decrease after organizing a neurovascular subspecialty.
The outcome after clipping of ruptured SAH can be largely affected by the surgeon's experience and postoperative intensive care. Organizing a neurovascular team is one of the major factors to achieve good outcomes.
未能预防脑蛛网膜下腔出血（SAH）后再出血是动脉瘤性SAH高发病率和高死亡率的最常见原因。我们的研究旨在确定在神经血管单元建立前后，对动脉瘤性SAH进行手术夹闭后的结果。将讨论结果中积极转变的相关说明。
对我们在2015年1月至2019年12月期间对一组接受破裂脑动脉瘤夹闭术的对照患者（n = 61）的经验进行回顾性队列分析。采用改良Rankin量表（mRS）来确定随访6个月后的结果。
入院时mRS评分中位数（即结果）为4，而夹闭术后6个月时中位数评分为2（P≤0.001）。总体而言，样本中预后良好的病例占63.9%，而预后不良的情况占36.1%。大多数预后改善的病例是在引入神经血管单元之后，这代表了我们中心动脉瘤夹闭术实践的转变。良好预后从42%变为76.7%，不良预后从58%变为23.3%（P = 0.019）。粗死亡率与全球水平相似（18%），在组建神经血管亚专业后有明显下降。
破裂性SAH夹闭术后的结果在很大程度上可能受外科医生经验和术后重症监护的影响。组建神经血管团队是取得良好结果的主要因素之一。
