Pagkou Diamantoula, Fotakopoulos George, Kogias Evangelos, Papadopoulou Kiriaki, Patsalas Ioannis, Foroglou Nikolaos
Department of Neurosurgery, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece.
Med Int (Lond). 2025 Jul 31;5(5):58. doi: 10.3892/mi.2025.257. eCollection 2025 Sep-Oct.
Aneurysmal subarachnoid hemorrhage (SAH) constitutes a devastating and life-threatening neurosurgical emergency. Over a number of years, there has been a debate as regards the most suitable timing for surgery. The present retrospective study aimed to investigate the association between the timing of treatment and the outcomes of patients who underwent clipping of ruptured intracranial aneurysms. The present study performed a retrospective analysis of 92 of 142 consecutive patients who were diagnosed with anterior circulation ruptured aneurysms and treated only by microsurgical clipping between January, 2013 and December, 2018. The patients were divided into two groups, namely group A, which included patients who underwent microsurgical clipping for ruptured anterior circulation aneurysm in the early stages (within the first 3 days of aneurysm rupture occurrence), and group B, which included those who were operated on in the late stages (after 3 days of aneurysm rupture occurrence). The age of the patients ranged from 26 to 78 years, with a mean age of 54.6 years. In total, 52 patients were female (56.6%) and 40 patients were male (43.4%). Risk factors associated with a high incidence of rupture included hypertension in 47 (51.0%) patients, cigarette smoking in 39 (42.3%) patients, alcohol consumption in 20 (21.7%) patients and diabetes mellitus in 2 (2.1%) patients. The present study revealed that the mortality rate was lower in group B (P=0.011; 4.3% compared with 11.9% in group A). This indicates that particularly the timing of surgery in group B (patients who were operated on in the late stages, after 3 days of aneurysm rupture occurrence) was more appropriate. In addition, no complications, post-operative hemiplegia and mortality were all independent factors associated with good outcomes (≥2 modified Rankin scale) (P<0.05 for all three parameters). On the whole, the present study demonstrates that the outcomes of patients who underwent microsurgical clipping for ruptured anterior circulation aneurysms ≥3 days after admission or rupture occurrence, exhibited favorable outcomes compared to patients operated on during the first 2 days of occurrence.
动脉瘤性蛛网膜下腔出血（SAH）是一种毁灭性的、危及生命的神经外科急症。多年来，关于最合适的手术时机一直存在争议。本回顾性研究旨在调查治疗时机与接受破裂颅内动脉瘤夹闭术患者预后之间的关联。本研究对2013年1月至2018年12月期间连续诊断为前循环破裂动脉瘤且仅接受显微手术夹闭治疗的142例患者中的92例进行了回顾性分析。患者分为两组，即A组，包括早期（动脉瘤破裂发生后3天内）接受前循环破裂动脉瘤显微手术夹闭的患者；B组，包括晚期（动脉瘤破裂发生3天后）接受手术的患者。患者年龄在26至78岁之间，平均年龄为54.6岁。共有52例女性患者（56.6%）和40例男性患者（43.4%）。与高破裂发生率相关的危险因素包括47例（51.0%）患者患有高血压、39例（42.3%）患者吸烟、20例（21.7%）患者饮酒以及2例（2.1%）患者患有糖尿病。本研究显示，B组的死亡率较低（P = 0.011；4.3%，而A组为11.9%）。这表明特别是B组（晚期手术患者，动脉瘤破裂发生3天后）的手术时机更合适。此外，无并发症、术后偏瘫和死亡率均是与良好预后（改良Rankin量表评分≥2分）相关的独立因素（所有三个参数P < 0.05）。总体而言，本研究表明，入院或破裂发生≥3天后接受前循环破裂动脉瘤显微手术夹闭的患者，与在发生后的头2天内接受手术的患者相比，预后良好。
