gms | German Medical Science

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

Management in aneurysmal subarachnoid hemorrhage: A prospective study of outcome comparing early surgical versus endovascular treatment in 361 cases

Behandlunsgstrategien bei der aneurysmatischen Subarachnoidalblutung: Eine prospektive Untersuchung an 361 Fällen zum Vergleich zwischen mikrochirurgischer und endovaskulärer Therapie

Meeting Abstract

  • K. Geletneky - Klinik für Neurochirurgie, Ruprecht-Karls-Universität Heidelberg, Heidelberg
  • P. Kremer - Klinik für Neurochirurgie, Ruprecht-Karls-Universität Heidelberg, Heidelberg
  • G. Ranaie - Klinik für Neurochirurgie, Ruprecht-Karls-Universität Heidelberg, Heidelberg
  • R. Wirtz - Klinik für Neurochirurgie, Ruprecht-Karls-Universität Heidelberg, Heidelberg
  • M. Hartmann - Klinik für Neurochirurgie, Ruprecht-Karls-Universität Heidelberg, Heidelberg
  • S. Haehnel - Klinik für Neurochirurgie, Ruprecht-Karls-Universität Heidelberg, Heidelberg
  • A. Unterberg - Klinik für Neurochirurgie, Ruprecht-Karls-Universität Heidelberg, Heidelberg
  • S. Kunze - Klinik für Neurochirurgie, Ruprecht-Karls-Universität Heidelberg, Heidelberg
  • corresponding author Hans Herbert Steiner - Klinik für Neurochirurgie, Ruprecht-Karls-Universität Heidelberg, Heidelberg

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.08.09

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2004/04dgnc0231.shtml

Published: April 23, 2004

© 2004 Geletneky et al.
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Outline

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Objective

This prospective study was conducted to document the influence of treatment modality, surgical (ST) versus endovascular techniques (ET), on clinical outcome in acute aneurysmal subarachnoid hemorrhage.

Methods

A total of 361 patients (1997-2001) were initially assigned either to surgical, 246 aneurysms, or endovascular treatment, 115 aneurysms. Using the WFNS grading scale, 197 patients were grade I+II (ST 138/56% vs. ET 59/51%), 74 patients were grade III (ST 49 vs. ET 25) and 90 patients were grade IV and V (ST 59/23.8% vs. ET 31/26.8%). There were no statistically significant differences in clinical characteristics between the two treatment groups, besides a greater freqency of posterior circulation aneurysms treated by ET (23.1% vs. 3.4%) and a slightly higher amount of poor grade aneurysms in the endovascular group (26.8% vs. 23.8%).

Results

Technique-related complication rates turned out to be higher in ET patients (17.1% vs. 5.7%), but the overall morbidity looked similar for both groups (ST 10/4% vs. 6/5.2%). In WFNS grade I+II aneurysms clinical outcome was regulary excellent using the Glasgow-Outcome-Scale (GOS 4 and 5), independent of the employed techniques (ST 124/89% vs. ET 50/85%). Less favourable results in grade I+II showed 12 of 138 surgical and 7 of 59 endovascular treated patients. In poor grade aneurysms, 24 patients (41%) after clipping showed good results (7/23% in the endovascular group), but mortality remains high (ST 17/29% vs. ET 15/49%).

Conclusions

Clinical outcome seems comparable after surgical and endovascular treatment of ruptured intracranial aneurysms. The higher technique-related morbidity in endovascular treatment, which is in contrast to the results of the ISAT study, may be leaded to a elevated amount of poor grade aneurysms in this group and. The long-term efficacy of endovascular treatment in preventing rebleeding still remains open.