gms | German Medical Science

57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

11. bis 14.05.2006, Essen

The outcome of aneursymal subarachnoid hemorrhage following treatment with endovascular coiling or neurosurgical clipping according to a new protocol

Ergebnisse der interventionellen und chirurgischen Behandlung nach aneurysmatischer SAB unter Anwendung eines neuen Protokolls

Meeting Abstract

  • corresponding author B. Meyer - Neurochirurgische Universitätsklinik Bonn
  • F. Ringel - Neurochirurgische Universitätsklinik Bonn
  • N. Gharevi - Neurochirurgische Universitätsklinik Bonn
  • A. Spottke - Neurologische Universitätsklinik Bonn
  • H. Urbach - Radiologische Universitätsklinik Bonn
  • R. Dodel - Neurologische Universitätsklinik Bonn

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocFR.06.05

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2006/06dgnc037.shtml

Veröffentlicht: 8. Mai 2006

© 2006 Meyer et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: To evaluate the clinical outcomes, costs and health-related quality of life in patients with ruptured intracranial aneurysms in a German University healthcare setting after the installation of a new and strict treatment protocol subsequent to the ISAT results. The question was how and whether the hypothetical advantage of endovascular coiling translates into reality.

Methods: N=133 consecutive patients admitted with aneurysmal SAH between January 2004 and June 2005 were entered into a prospective 120-item-database, which was exclusively run and evaluated by a third party. All patients were considered primary candidates for coiling. Criteria for cross-over to surgery were pre-hoc defined in accordance with AHA-accepted guidelines (American Heart Association) and applied on an individual basis by the neurosurgical/-radiological team. Each patient underwent a complete medical and neurological examination, including a uniform, structured assessment using different clinical scales (NIHSS, GCS, WFNS) but also impairment scales (Rankin, Barthel) on admission, at discharge and at 6,12,24 months. Health-related Qol (HRQoL) was assessed using the EQ-5D and the SF-36. Depression was evaluated with the Beck’s depression Inventory. Costs (direct and indirect) were assessed based via a structured questionnaire administered at the different time points (perspective: healthcare provider). In this abstract the data that is available so far in the six months evaluation period is presented.

Results: The mean age was 53.1±15.3 with 65% females. 52 patients underwent treatment with endovascular detachable-coils (NR) and 47 patients craniotomy and clipping (NCH). 2 patients were dead at 6 months. Intraprocedural side effects were documented for NR in 18 patients and for NCH in 14 patients. Rankin-Score at 6 months (baseline) was for the NR-group 2.4±1.5 and for the NCH group 1.5±1.7. HRQoL (EQ-5D-VAS) was 32.8 at discharge for NR and 50.4 for NCH and improved after 6 months to 61.7 and 66.5, respectively.

Conclusions: These preliminary results, which is substantiated with the complete data set in the next 3 months, indicate the following: Despite a hypothetical advantage due to the algorithm of selection and according to the experience extrapolated from the ISAT results, in this specific setting outcome may be equally favourable in both groups. The results and the experience acquired here can be considered as a rational basis for developing a scenario for a large multicenter trial in the German healthcare setting.