Ronne-Engström Elisabeth, Borota Ljubisa, Lenell Samuel, Lewén Anders, Mahmoud Ehab, Nyberg Christoffer, Velle Fartein, Enblad Per
Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden.
Department of Surgical Sciences, Section of Radiology, Uppsala University, Uppsala, Sweden.
Acta Neurochir (Wien). 2024 Apr 22;166(1):188. doi: 10.1007/s00701-024-06069-z.
Improved endovascular methods make it possible to treat complex ruptured aneurysms, but surgery is still needed in certain cases. We evaluated the effects on the clinical results of the changes in aneurysm treatment.
The study cohort was 837 patients with spontaneous subarachnoid hemorrhage (SAH) and one or multiple aneurysms, admitted to Dept of Neurosurgery, Uppsala University Hospital from 2012 to 2021. Demography, location and treatment of aneurysms, neurologic condition at admission and discharge, mortality and last tier treatment of high intracranial pressure (ICP) was evaluated. Functional outcome was measured using the Extended Glasgow Outcome Scale (GOSE) Data concerning national incidences of stroke diseases was collected from open Swedish databases.
Endovascular methods were used in 666 cases (79.6%). In 111 (13.3%) with stents. Surgery was performed in 115 cases (13.7%) and 56 patients (6.7%) had no aneurysm treatment. The indications for surgery were a hematoma (51 cases, 44.3%), endovascular treatment not considered safe (47 cases, 40.9%), or had been attempted without success (13 cases, 11.3%). Treatment with stent devices increased, and with surgery decreased over time. There was a trend in decrease in hemicraniectomias over time. Both the patient group admitted awake (n = 681) and unconscious (n = 156) improved significantly in consciousness between admission and discharge. Favorable outcome (GOSE 5-8) was seen in 69% for patients admitted in Hunt & Hess I-II and 25% for Hunt & Hess III-V. Mortality at one year was 10.9% and 42.7% for those admitted awake and unconscious, respectively.The number of cases decreased during the study period, which was in line with Swedish national data.
The incidence of patients with SAH gradually decreased in our material, in line with national data. The treatment policy in our unit has been shifting to more use of endovascular methods. During the study period the use of hemicraniectomies decreased.
改进的血管内治疗方法使治疗复杂破裂动脉瘤成为可能，但在某些情况下仍需要手术治疗。我们评估了动脉瘤治疗变化对临床结果的影响。
研究队列包括2012年至2021年入住乌普萨拉大学医院神经外科的837例自发性蛛网膜下腔出血（SAH）且伴有一个或多个动脉瘤的患者。评估了患者的人口统计学特征、动脉瘤的位置和治疗情况、入院和出院时的神经状况、死亡率以及高颅内压（ICP）的最终治疗情况。使用扩展格拉斯哥预后量表（GOSE）测量功能结局。从瑞典公开数据库收集有关全国中风疾病发病率的数据。
666例（79.6%）使用了血管内治疗方法。其中111例（13.3%）使用了支架。115例（13.7%）接受了手术治疗，56例（6.7%）未进行动脉瘤治疗。手术的指征包括血肿（51例，44.3%）、血管内治疗不安全（47例，40.9%）或尝试血管内治疗未成功（13例，11.3%）。随着时间的推移，支架装置的使用增加，而手术治疗减少。随着时间的推移，去骨瓣减压术有减少的趋势。入院时清醒（n = 681）和昏迷（n = 156）的患者组在入院和出院之间意识均有显著改善。Hunt & Hess I-II级入院患者的良好结局（GOSE 5 - 8）为69%，Hunt & Hess III - V级入院患者为25%。入院时清醒和昏迷患者的一年死亡率分别为10.9%和42.7%。在研究期间病例数减少，这与瑞典国家数据一致。
在我们的研究资料中，SAH患者的发病率逐渐下降，与国家数据一致。我们科室的治疗策略已转向更多地使用血管内治疗方法。在研究期间，去骨瓣减压术的使用减少。
