Surgical treatment of complicated aneurysmаl SAH. An analysis of treatment results when using endovascular coiling or microsurgical clipping of aneurysm

Abstract

Aim – to compare the treatment results of the acute period of aneurysmal subarachnoid hemorrhage (SAH) with a complicated course depending on the method used for occlusion of the aneurysm - microsurgical clipping or endovascular coiling.Material and methods. The treatment results of patients with aneurysmal SAH were analyzed, among which 124 cases (49.6 %) with the complicated course were identified and divided into a “coiling” group and a “clipping” group. The severity of SAH was determined using the Hunt-Hess and WFNS clinical scales, and the Fisher radiological scale. The result was evaluated according to the modified Rankin scale (mRS).Results. Age gradation and gender differences in the compared groups did not have a significant difference. An almost equal number of aneurysms of the anterior cerebral - anterior communicating artery complex was noted, 54.84 % in the “coiling” group and 61.29 % in the “clipping” group. The “coiling” group was dominated by internal carotid artery aneurysms (32.26 %), while middle cerebral artery aneurysms prevailed in the “clipping” group (35.48 %). There were no significant differences in the severity of SAH (mean value (mv)): WFNS in the “coiling” group – 2.1 and Hunt–Hess – 2.63, in the “clipping” group – 2.1 and 2.7, respectively; the mv on the Fisher scale was3.5 in the “coiling” and 3.4 – in the “clipping” group. The mv of the dysfunction degree according to mRS amounted to2.64 in the “coiling” group and3.5 in the “clipping” group. A good treatment result (mRS score of 1–2) was noted in 67.7 % of cases in the “coiling” group, while in the “clipping” group – in 37.1 %. Mortality rate was 17.7 % in the “coiling” group and 19.3 % – in the “clipping” group. There was a direct correlation between the SAH severity according to the Hunt–Hess and WFNS scales and mRS. There was no correlation between the SAH severity according to the Fisher scale and mRS.Conclusions. With the same severity of complicated aneurysmal SAH according to the generally accepted scales, the functional treatment outcome was better in the “coiling” group. The Fisher scale did not correlate with the functional outcome defined by mRS. Microsurgical “clipping” often resulted in the development of shunt-dependent hydrocephalus.