Prognostic observation of endovascular embolization for high grade intracranial aneurysms after conservation treatment

Abstract

Objective To observe the prognosis of patients with Hunt-hess lV-V grade of intracranial saccular aneurysms who were treated with conservative therapy. Methods The clinical date of 64 patients with Hunt-Hess grade Ⅳ-Ⅴ intracranial saccular aneurysm (grade Ⅳ, n=48 and grade Ⅴ, n=16) admitted to Fist Department of Neurosurgery of Affiliated Zhongshan Hospital of Dalian University from January 2012 to December 2017 were analyzed retrospectively. Thirty two cases of them were treated with conservative therapy in which the state of consciousness was better than before or the pupil was smaller than before,and then they were treated with embolization and continuous lumbar drainage(postpone surgery group) and 32 underwent emergency embolization and continuous lumbar drainage(immediate surgery group). The neurological prognosis of the patients was evaluated at 1, 3 and 6 months. Results There was no significant difference in Glasgow outcome scores between the postpone surgery group and immediata surgery group at one month after treatment (P>0.05); there was no significant difference in Rankin prognostic scores at three months after treatment (P>0.05); But there was significant difference in Rankin prognostic scores at six months after treatment between the two groups (P<0.05). Conclusion Patients with high grade cystic aneurysmal subarachnoid hemorrhage can be treated with conservation treatment. When patients were treated with conservative therapy in which the state of consciousness was better than before or the pupil was smaller than before,endovascular embolization and continuous lumbar drainagemay be performed. The prognosis at six months is better than emergency embolization and continuous lumbar drainage. Key words: High grade subarachnoid hemorrhage; Intracranial aneurysms; Endovascular embolization