Adverse events associated with microsurgial treatment for ruptured intracerebral aneurysms: a prospective nationwide study on subarachnoid haemorrhage in Sweden

Baldvinsdóttir, Bryndís; Kronvall, Erik; Ronne-Engström, Elisabeth; Enblad, Per; Lindvall, Peter; Aineskog, Helena; Friðriksson, Steen; Klurfan, Paula; Svensson, Mikael; Alpkvist, Peter; Hillman, Jan; Eneling, Johanna; Nilsson, Ola

doi:10.1136/jnnp-2022-330982

Cited by 7 publications

(1 citation statement)

References 37 publications

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“…It is generally known that the brain after SAH is vulnerable to additional injury from surgical manipulation, and therefore early surgery should avoided when the patient is in a bad clinical condition. In a recent analysis of a Swedish nationwide prospective study, 25% of those treated with surgery had adverse events associated with the operation, and this was related to a worse outcome [ 3 ]. In the same study, 13% of those treated with endovascular techniques had complications in association with the treatment [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Trends in incidence and treatments of spontaneous subarachnoid hemorrhage- a 10 year hospital based study

Ronne-Engström,

Borota,

Lenell

et al. 2024

Acta Neurochir

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Background 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. Methods 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. Results 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. Conclusions 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.

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Section: Discussionmentioning

confidence: 99%

Trends in incidence and treatments of spontaneous subarachnoid hemorrhage- a 10 year hospital based study

Ronne-Engström,

Borota,

Lenell

et al. 2024

Acta Neurochir

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Acute evacuation of 54 intracerebral hematomas (aICH) during the microsurgical clipping of a ruptured middle cerebral artery bifurcation aneurysm—illustration of the individual clinical courses and outcomes with a serial brain CT/MRI panel until 12 months

Autio,

Paavola,

Tervonen

et al. 2024

Acta Neurochir

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Purpose In aneurysmal intracerebral hemorrhage (aICH), our review showed the lack of the patient’s individual (i) timeline panels and (ii) serial brain CT/MRI slice panels through the aICH evacuation and neurointensive care until the final brain tissue outcome. Methods Our retrospective cohort consists of 54 consecutive aICH patients from a defined population who acutely underwent the clipping of a middle cerebral artery bifurcation saccular aneurysm (Mbif sIA) with the aICH evacuation at Kuopio University Hospital (KUH) from 2010 to 2019. We constructed the patient’s individual timeline panels since the emergency call and serial brain CT/MRI slice panels through the aICH evacuation and neurointensive care until the final brain tissue outcome. The patients were indicated by numbers (1.–54.) in the pseudonymized panels, tables, results, and discussion. Results The aICH volumes on KUH admission (median 46 cm3) plotted against the time from the emergency call to the evacuation (median 8 hours) associated significantly with the rebleeds (n=25) and the deaths (n=12). The serial CT/MRI slice panels illustrated the aICHs, intraventricular hemorrhages (aIVHs), residuals after the aICH evacuations, perihematomal edema (PHE), delayed cerebral injury (DCI), and in the 42 survivors, the clinical outcome (mRS) and the brain tissue outcome. Conclusions Regarding aICH evacuations, serial brain CT/MRI panels present more information than words, figures, and graphs. Re-bleeds associated with larger aICH volumes and worse outcomes. Swift logistics until the sIA occlusion with aICH evacuation is required, also in duty hours and weekends. Intraoperative CT is needed to illustrate the degree of aICH evacuation. PHE may evoke uncontrollable intracranial pressure (ICP) in spite of the acute aICH volume reduction.

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Partial coil embolization before surgical clipping of ruptured intracranial aneurysms

Mistry,

Naidugari,

Meyer

et al. 2024

Acta Neurochir

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Adverse events associated with microsurgial treatment for ruptured intracerebral aneurysms: a prospective nationwide study on subarachnoid haemorrhage in Sweden

Cited by 7 publications

References 37 publications

Trends in incidence and treatments of spontaneous subarachnoid hemorrhage- a 10 year hospital based study

Trends in incidence and treatments of spontaneous subarachnoid hemorrhage- a 10 year hospital based study

Acute evacuation of 54 intracerebral hematomas (aICH) during the microsurgical clipping of a ruptured middle cerebral artery bifurcation aneurysm—illustration of the individual clinical courses and outcomes with a serial brain CT/MRI panel until 12 months

Partial coil embolization before surgical clipping of ruptured intracranial aneurysms

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