Management of aneurysmal subarachnoid haemorrhage with intracerebral hematoma: Is there an indication for coiling first? Study of 44 cases

Salaud, Céline; Hamel, Olivier; Riem, Tanguy; Desal, Hubert; Buffenoir, K.

doi:10.1177/1591019915617320

Cited by 9 publications

(6 citation statements)

References 22 publications

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“…Our findings align with those of previous studies showing an increase in endovascular treatment over surgical treatment [ 2 , 17 , 23 , 30 , 37 , 38 ]. Notably, the shift in our center occurred almost a decade later than in the USA (2007 vs. 2017) [ 2 , 37 ].…”

Section: Discussionsupporting

confidence: 93%

“…We noticed a general decrease in the number of treated intracranial aneurysms, both ruptured and unruptured. It has been speculated that the incidence of ruptured aneurysms has decreased as a result of successful prophylactic treatment of high-risk unruptured aneurysms [ 37 ]; however, it is more likely a consequence of decreased rates of smoking and hypertension [ 16 , 22 , 44 , 45 ]. Moreover, the declining treatment rate of unruptured aneurysms is also affected by local policies; for example, treatment is nowadays rarely offered to patients with small aneurysms in locations that rarely rupture (e.g., paraopthalmic aneurysms [ 19 ]) or to elderly patients whose treatment-related complication rate surpasses the risks related to the natural history of the aneurysm [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…The trial results—that showed improved functional outcomes in good grade (World Federation of Neurosurgical Societies grade I–III) SAH after endovascular versus surgical treatment from an internal carotid (ICA) or posterior circulation aneurysm—were heavily extrapolated to include all intracranial aneurysms, independent of location, rupture status, or used endovascular technique [ 2 ]. While there is a paucity in the level of evidence supporting the shift from surgical to endovascular treatment, the shift has continued [ 37 ]. The transition towards endovascular treatment has happened at different paces depending on the local traditions and circumstances.…”

Section: Introductionmentioning

confidence: 99%

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Changes in treatment of intracranial aneurysms during the last decade in a large European neurovascular center

Calvanese,

Auricchio,

Pohjola

et al. 2024

Acta Neurochir

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Objective Treatment modality for ruptured and unruptured intracranial aneurysms has shifted during the last two decades from microsurgical treatment towards endovascular treatment. We present how this transition happened in a large European neurovascular center. Methods We conducted a retrospective observational study consecutive patients treated for an unruptured or ruptured intracranial aneurysm at Helsinki University Hospital during 2012–2022. We used Poisson regression analysis to report age-adjusted treatment trends by aneurysm location and rupture status. Results A total of 2491 patients with intracranial aneurysms were treated (44% ruptured, 56% unruptured): 1421 (57%) surgically and 1070 (43%) endovascularly. A general trend towards fewer treated aneurysms was noted. The proportion of patients treated surgically decreased from 90% in 2012 to 20% in 2022. The age-adjusted decrease of surgical versus endovascular treatment was 6.9%/year for all aneurysms, 6.8% for ruptured aneurysms, and 6.8% for unruptured aneurysms. The decrease of surgical treatment was most evident in unruptured vertebrobasilar aneurysms (10.8%/year), unruptured communicating artery aneurysms (10.1%/year), ruptured communicating artery aneurysms (10.0%/year), and ruptured internal carotid aneurysms (9.0%/year). There was no change in treatment modality for middle cerebral artery aneurysms, of which 85% were still surgically treated in 2022. A trend towards an increasing size for treated ruptured aneurysms was found (p = 0.033). Conclusion A significant shift of the treatment modality from surgical to endovascular treatment occurred for all aneurysm locations except for middle cerebral artery aneurysms. Whether this shift has affected long-term safety and patient outcomes should be assessed in the future.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Changes in treatment of intracranial aneurysms during the last decade in a large European neurovascular center

Calvanese,

Auricchio,

Pohjola

et al. 2024

Acta Neurochir

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“…Передбачається, що ця стратегія може зменшувати частоту повторного розриву аневризми і приводити до меншої кількості інтраопераційних ускладнень. Однак, з іншого боку, емболізація аневризми поєднана з евакуацією ВМГ, приводить до збільшення часу перед етапом евакуації ВМГ і більш тривалим періодом підвищення внутрішньочерепного тиску [8].…”

Section: введенняunclassified

Two-stage surgical treatment of subarachnoid and paryhymatous blood effects with the use of endovascular embolization of damaged aneurysm

Polkovnikov

Kutovoy

2019

The Journal of v. N. Karazin Kharkiv National University, Series "Medicine"

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Introduction. Aneurysmal subarachnoid hemorrhage (SAH) is complicated by concomitant intracerebral hemorrhage (IUD) with a frequency of 4% to 42.5%. More than 80% of patients die in conservative therapy, and when removing only hematomas without occlusion of an aneurysm, the mortality rate reaches 75%. Objectives. The aim of the study was the optimization of treatment of aneurysmatic subarachnoid haemorrhage complicated by the formation of intracerebral hematoma. Materials and methods. The analysis of the results of surgical treatment of 101 patients in the acute period of cerebral aneurysm rupture was performed. The first group of observations in which the surgical treatment was limited to endovascular occlusion of cerebral aneurysms. In the second group of observations, multi-stage surgical treatment was performed - endovascular embolization of cerebral aneurysm with subsequent removal of parenchymal hematoma for 24–48 hours. Results. In most cases, surgical treatment was limited to endovascular embolization of the ruptured aneurysm. In 3 observations, multistage surgical treatment was performed - endovascular embolization of cerebral aneurysm with subsequent removal of intracerebral hematoma. In two cases, positive dynamics with a regression of neurological deficits in the postoperative period was noted. In one observation, partial regression of motor deficit. Conclusions. Two - stage surgical treatment of subarachnoid haemorrhage with intracerebral hematoma the use of endovascular embolization of the ruptured aneurysm and subsequent evacuation of hematoma is effective and can be used in cases where there is a technical possibility of occlusion of the aneurysm s and the compensated state of the patient.

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“…Наявність паренхіматозної гематоми, яка спричиняє стиснення і дислокацію мозку, рутинно вважають критерієм вибору транскраніального втручання. Однак у низці досліджень результати транскраніального або пункційного видалення паренхіматозної гематоми протягом 24 год після ендоваскулярної оклюзії аневризми порівнянні з результатами кліпування з одночасним видаленням паренхіматозної гематоми [7,8]. У нашій серії відзначено добрe функціональне відновлення після багатоетапного хірургічного лікування, коли першим етапом було виконано ендоваскулярну оклюзію аневризми, а другим -евакуацію гематоми.…”

Section: обговоренняunclassified

Endovascular combined and multistep surgical treatment of complicated intracranial aneurysmal hemorrhage

Polkovnikov¹,

Матерухін²,

Polkovnikova³

2018

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Результати. За тяжкістю субарахноїдального крововиливу за шкалою Hunt-Hess розпо-*Conflict of Interest Statement (We declare that we have no conflict of interest). *Заява про конфлікт інтересів (Ми заявляємо, що у нас немає ніякого конфлікту інтересів). *Заявление о конфликте интересов (Мы заявляем, что у нас нет никакого конфликта интересов). *No human/animal subjects policy requirements or funding disclosures. *Жодний із об'єктів дослідження (людина/тварина) не підпадає під вимоги політики щодо розкриття інформації фінансування. *Ни один из объектов исследования не подпадает под политику раскрытия информации финансирования. *Date of submission-01.09.18 *Дата подачі рукопису-01.09.18 *Дата подачи рукописи-01.09.18 *Date of acceptance-12.09.18 *Дата ухвалення-12.09.18 *Дата одобрения к печати-12.09.18

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Management of aneurysmal subarachnoid haemorrhage with intracerebral hematoma: Is there an indication for coiling first? Study of 44 cases

Cited by 9 publications

References 22 publications

Changes in treatment of intracranial aneurysms during the last decade in a large European neurovascular center

Changes in treatment of intracranial aneurysms during the last decade in a large European neurovascular center

Two-stage surgical treatment of subarachnoid and paryhymatous blood effects with the use of endovascular embolization of damaged aneurysm

Endovascular combined and multistep surgical treatment of complicated intracranial aneurysmal hemorrhage

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