Emergency microsurgery for aneurysmal subarachnoid hemorrhage coexisted with brain hernia

Abstract

AIm: This work aims to summarize the experience in emergency microsurgery for patients with aneurysmal subarachnoid hemorrhage (SAH) that coexisted with brain hernia. mATERIAL and mETHods: A total of 26 patients with aneurysmal SAH complicated by brain hernia were subjected to emergency aneurysm clamping + decompressive craniectomy. 10 patients were diagnosed with aneurysmal SAH coexisted with brain hernia before operation. REsuLTs:Four patients had a carotid aneurysm, 15 had a middle artery aneurysm, and 7 had an anterior communicating aneurysm. The surgical procedure was performed smoothly for all patients. The patients were followed up for 3 months to 6 months. According to Glasgow outcome scaling, five patients recovered well, six suffered from moderate disability, five were subjected to severe disability, five were in plant survival, and 5 died. CoNCLusIoN: Emergency surgical exploration is an effective treatment method for patientsKEywoRds: Aneurysm, Brain hernia, Emergency, Subarachnoid hemorrhage, Surgery ÖZ AmAÇ: Çalışma, beyin herniasyonuna eşlik eden anevrizmal subaraknoid kanama (SAK) hastalarında acil mikrocerrahi deneyimini özetlemeyi amaçlamaktadır. yÖNTEm ve GEREÇLER: Beyin herniasyonu ile komplike anevrizmal SAK'sı olan 26 hastada acil anevrizma klipleme + dekompresif kraniyektomi yapıldı. 10 hastaya ameliyattan önce beyin herniasyonuna eşlik eden anevrizmal SAK tanısı konuldu.BuLGuLAR: Dört hastada karotid anevrizma, 15'inde orta serebral arter anevrizması ve 7'sinde anterior komünikan arter anevrizması vardı. Cerrahi müdahale bütün hastalarda sorunsuz uygulandı. Hastalar 3 ila 6 ay boyunca takip edildi. Glasgow sonuç ölçekleme yöntemine göre beş hasta tam iyileşti, altısı orta derecede, beşi ise ciddi maluliyet yaşadı. Beş hasta bitkisel hayata girdi ve beşi ise öldü. soNuÇ: Acil cerrahi hastalar için etkili bir tedavi yöntemidir.

Primary decompressive craniectomy in poor-grade aneurysmal subarachnoid hemorrhage: long-term outcome in a single-center study and systematic review of literature

“…One possible reason might be the worse initial clinical condition of patients in our PDC group (additional ICH, cerebral herniation, WFNS grade 5) compared with the PDC patients in literature research. Thus we had, for example, a high percentage of cases with cerebral herniation (58%) and WFNS grade 5 (87%), compared with other publications (e.g., Lu et al [22]: 33% cerebral herniation and 46% WFNS grade 5).…”

“…There was one additional record through checking the reference lists of the included studies. Of the 248 records screened, 29 full-text articles were assessed for eligibility, 9 of which met the inclusion criteria [3,6,8,21,22,26,27,30,38]. Data of the 9 included studies are summarized in Table 4.…”

“…Confirming our hypothesis, Kazumata et al stated that an aggressive decompression in "acute stage may prevent significant postoperative brain swelling." From the studies of Lu et al [22], Arikan et al [3], and Zhao et al [38], no separate patient data was needed to be extracted. In both studies, only cases of PDC in poor-grade aSAH patients were presented with rates of a favorable outcome of 42% (Lu et al [22]), 36% (Arikan et al [3]), and even 58% (Zhao et al [38]).…”

“…From the studies of Lu et al [22], Arikan et al [3], and Zhao et al [38], no separate patient data was needed to be extracted. In both studies, only cases of PDC in poor-grade aSAH patients were presented with rates of a favorable outcome of 42% (Lu et al [22]), 36% (Arikan et al [3]), and even 58% (Zhao et al [38]). Moreover, Zhao et al reported about their control group without DC, in which overall 57% of the patients achieved a favorable outcome, which lead the author to the statement that PDC "does not seem to be significantly associated with improved outcomes.…”

Effects of decompressive craniectomy on functional outcomes and death in poor-grade aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis

“…Detailed study parameters and summary statistics from all included studies (with and without a matched control group) that investigated DC in patients with poor-grade aSAH are listed in Tables 2 and 3, respectively. Of the 15 studies included in this review, all of them were observational cohorts (2 prospective, 27,52 13 retrospective 7, 10,21,[24][25][26]28,34,35,39,44,45,47 ). The years of publication ranged from 2002 to 2015, and the reports represented findings from North America (2 studies), Europe (5), and Asia (8).…”