Atallah Oday, Alrefaie Khadeja, Badary Amr
Department of Neurosurgery, Evangelic Hospital Oldenburg, Carl Von Ossietzky University Oldenburg, 26122 Oldenburg, Germany.
Kuwait Institute for Medical Specialization, Sulibekhat 15503, Kuwait.
J Clin Med. 2025 Jul 3;14(13):4705. doi: 10.3390/jcm14134705.
Subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysms remains a critical neurosurgical emergency with high morbidity and mortality. The presence of multiple intracranial aneurysms (MIAs) in SAH patients presents a therapeutic challenge, particularly in choosing between single-stage and multiple-stage interventions. In patients with aneurysmal SAH and multiple intracranial aneurysms, we compared single-stage vs. multiple-stage interventions regarding vasospasm occurrence, complication rates, and short-term neurological outcomes in a retrospective cohort. This retrospective cohort study included 44 patients diagnosed with aneurysmal SAH and at least one additional unruptured aneurysm. Patients were categorized based on the intervention strategy. A "single-stage" intervention was defined as treatment of both the ruptured and all unruptured aneurysms in the same operative session. A "multiple-stage" intervention referred to a planned approach in which additional aneurysms were treated in separate, subsequent procedures. Clinical severity was assessed using scores. Aneurysm characteristics and treatment modalities were recorded. Outcomes were analyzed and compared between intervention groups. Statistical analysis was performed, with < 0.05 considered significant. The cohort included 44 patients with a total of 109 aneurysms. Most patients were female (68.2%), with a mean age of 54.5 years. The majority of aneurysms were small- to medium-sized and commonly located in the anterior circulation. Among the patients, 19.0% underwent single-stage interventions, and 28.6% underwent multiple-stage procedures. Vasospasm occurred significantly more often in the single-stage group (83.9% vs. 46.2%, = 0.028). No significant difference was found in hospital stay duration between groups. The MRS scores showed a trend toward worse outcomes in the single-stage group ( = 0.060), as did the rates of post-operative neurological deficits ( = 0.079). In patients with SAH and MIAs, single-stage interventions may increase vasospasm risk. Although they offer logistical benefits, outcomes should be interpreted with caution given baseline differences and limited statistical adjustment.
颅内动脉瘤破裂导致的蛛网膜下腔出血（SAH）仍然是一种严重的神经外科急症，具有较高的发病率和死亡率。SAH患者中存在多发性颅内动脉瘤（MIAs）带来了治疗挑战，尤其是在单阶段和多阶段干预措施之间进行选择时。在患有动脉瘤性SAH和多发性颅内动脉瘤的患者中，我们在一项回顾性队列研究中比较了单阶段与多阶段干预在血管痉挛发生情况、并发症发生率和短期神经功能结局方面的差异。这项回顾性队列研究纳入了44例被诊断为动脉瘤性SAH且至少还有一个未破裂动脉瘤的患者。根据干预策略对患者进行分类。“单阶段”干预定义为在同一手术过程中治疗破裂动脉瘤和所有未破裂动脉瘤。“多阶段”干预是指一种计划性方法，即后续在单独的手术中治疗额外的动脉瘤。使用评分评估临床严重程度。记录动脉瘤特征和治疗方式。分析并比较干预组之间的结局。进行了统计分析，P<0.05被认为具有统计学意义。该队列包括44例患者，共有109个动脉瘤。大多数患者为女性（68.2%），平均年龄54.5岁。大多数动脉瘤为中小型，常见于前循环。在患者中，19.0%接受了单阶段干预，28.6%接受了多阶段手术。单阶段组血管痉挛的发生率明显更高（83.9%对46.2%，P = 0.028）。两组之间住院时间无显著差异。改良Rankin量表（MRS）评分显示单阶段组有结局更差的趋势（P = 0.060），术后神经功能缺损发生率也是如此（P = 0.079）。在患有SAH和MIAs的患者中，单阶段干预可能会增加血管痉挛风险。尽管它们具有后勤方面的优势，但鉴于基线差异和有限的统计调整，对结局的解读应谨慎。
