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55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

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Frequency of cerebral vasospasm and outcome after subarachnoid hemorrhage: Clipping versus coiling

Die Häufigkeit des zerebralen Vasospasmus und das Outcome nach Subarachnoidalblutung: operative versus endovaskuläre Behandlung

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  • corresponding author Alina Woszczyk - Klinik für Neurochirurige, Johann-Wolfgang-Goethe-Universität, Frankfurt/Main
  • A. Raabe - Klinik für Neurochirurige, Johann-Wolfgang-Goethe-Universität, Frankfurt/Main
  • R. Gerlach - Klinik für Neurochirurige, Johann-Wolfgang-Goethe-Universität, Frankfurt/Main
  • J. Beck - Klinik für Neurochirurige, Johann-Wolfgang-Goethe-Universität, Frankfurt/Main
  • M. Setzer - Klinik für Neurochirurige, Johann-Wolfgang-Goethe-Universität, Frankfurt/Main
  • V. Seifert - Klinik für Neurochirurige, Johann-Wolfgang-Goethe-Universität, Frankfurt/Main

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocDI.08.04

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2004/04dgnc0226.shtml

Published: April 23, 2004

© 2004 Woszczyk et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective

The influence of treatment modalities on the incidence of vasospasm in patients with subarachnoid hemorrhage (SAH) is still unknown. The aim of this study was to analyse the frequency of cerebral vasospasm within clipped and coiled patients.

Methods

After exclusion of patients with an unruptured aneurysm and untreated patients, a retrospective analyse (1999-2003) was performed including 223 patients with aneurysmal SAH. One hundred and forty three patients were treated by surgical clipping and 80 by endovascular coiling. Vasospasm was determined by the clinical symptoms of DIND, by postinterventional angiography, and by CT scanning at day 14. Analysis was performed for good grade (WFNS-1-3) and poor grade (WFNS-4-5) patients and for Fisher grade 1,2, and 4 versus grade 3 separately, patients sedated at admission were analysed in the poor WFNS grade group.

Results

The incidence of clinical symptomatic vasospasm in WFNS-1-3 was comparable in the coiled and clipped patients, and independent from Fisher grade (Fisher-1,2,4/coiled versus clipped OR 1,3; Fisher-3 OR 1,0). All Fisher-3/WFNS-4-5patients were sedated, not to evaluate clinically. There was not significant difference of new hyperdense areas in CT in the treatment groups. In all Fisher grades/WFNS-1-3 the angiographical visible vasospasm occurred more frequent in surgical treated patients (Fisher-1,2,4 36% versus 0%; Fisher-3 50% versus 29%), but this difference was not significant (Fisher exact test, p >0,2). In the WFNS-4-5 patients the risk for vasoconstriction was comparabale (Fisher exact test, p >0,6).

Conclusions

Neither difference in risk of clinical symptomatic vasospasm nor angiographical vasoconstriction could be identified between surgical and endovascular treatment.