gms | German Medical Science

Objective: Institutional results not focusing on mode of treatment or aneurysm location are rarely reported for patients after spontaneous subarachnoid hemorrhage (sSAH). The goal of this study is to critically evaluate our first experience after introduction of interdisciplinary treatment guidelines for patients with ruptured intracranial aneurysms.

Method: Diagnostic imaging, choice of treatment modality and postinterventional management after sSAH followed standardized operating procedures. Allocation of the patient to one treatment modality was based on an itemized catalogue with patient age, comorbidities and morphological characteristics of the aneurysm as the main elements. Outcome is presented as radiological outcome (aneurysm occlusion classes according to Raymond 2001: 1= complete, 2= residual neck, 3= incomplete) and early clinical outcome at time of discharge (modified Rankin scale, mRS, dichotomized into favourable (mRS 0-2) and unfavourable (mRS ≥3)).

Results: 52 of 58 consecutive patients with sSAH were retrospectively analyzed after introduction of the algorithm. In two patients the aneurysm was not treated due to poor clinical condition, advanced age and comorbidities, in 3 patients the angiography was negative and 1 patient died before treatment. 23 of 52 patients (44%) were treated by endovascular means. Mean age was 60 years (range 45 -80 ys), 19 females. Clinical grades were Hunt and Hess (HH) I +II n=5, HH III n=5, HH IV and V n=13. Aneurysm occlusion was class I n=21 (91%), class 2 n=1 (4.3%), and class 3 n=1 (4.3%). Clinical outcome as time of discharge (22 patients) was favorable in 6 (27%) and unfavourable in 16 (73%). N=29 (55%) oft 52 patients were treated microsurgically. Mean age was 51 years (range 28-73), 23 females. Clinical grades were HH I+II n= 15, HHIII n=7, HH IV+V n=7. Aneurysm occlusion was class I n=25 (86%), class 2 n=3 (10%), class 3 n=0 (0%). One patient died before control angiography. Clinical outcome at time of discharge (29 patients) was favorable in n=9 (31%) and unfavourable in n=20 (69%).There was no statistical significant difference between outcomes (aneurysm occlusion, P= 0.45, early clinical outcome P=0.76).

Conclusions: Institutional overall early outcome at time of discharge was not different for endovascular and microsurgical treatment of intracranial aneurysms when patients are treated within 24 hours after admission and a rigorous decision algorithm is applied.