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Short-term and long-term results of surgical treatment of ruptured tiny cerebral aneurysms: predictors of adverse outcomes

https://doi.org/10.56618/2071-2693_2024_16_1_32

EDN: AZMKUS

Abstract

INTRODUCTION. The choice of a method for surgical treatment of ruptured tiny aneurysms (TA) is often associated with great difficulties, due to the presence of microsurgical clipping (MC) and endovascular occlusion (EO) of their advantages and limitations in use.

AIM. To compare the results of treatment of ruptured TA depending on the chosen method for exclusion from the bloodstream, identification of possible predictors of an unfavourable outcome of a disease.

MATERIALS AND METHODS. A retrospective analysis of the treatment of 79 patients with aneurysmal subarachnoidal hemorrhage (SAH) due to cerebral TA rupture was performed, which were divided into two groups. The first group included 43 patients, who underwent endovascular surgery, the second one included 36 patients who underwent MC of the aneurysm. The initial severity of the condition, the presence of comorbidities, the need for additional surgical procedures, and the frequency of surgical treatment complications were studied. The treatment results were evaluated at the time of discharge from hospital, after 6 and 36 months.

RESULTS. Patients included in both study groups were comparable in terms of initial severity. Short-term and long-term treatment outcomes in the EO group were slightly better than in patients who underwent MC. However, statistical analysis did not identify any significant differences between the compared methods. Survival analysis did not identify any statistically significant differences depending on the chosen treatment method either. Predictors of lethal outcome in case of rupture of the arterial vein were identified, which included the severity of the condition according to the H-H, Fisher, Graeb and GCS scales, as well as the presence of concomitant neurosurgical benefits and late complications.

CONCLUSIONS. EO and MC remain complementary methods for the treatment of ruptured TA. When choosing a treatment method, if it is possible to use both methods, priority should be given to intravascular interventions, especially in the presence of sub- or decompensated somatic pathology.

About the Authors

A. P. Kornev
Stavropol regional clinical hospital
Russian Federation

Kornev Alexey Pavlovich,

1, Semashko str., Stavropol, 355029.



S. V. Ermakov
Stavropol regional clinical hospital
Russian Federation

Ermakov Sergey Vasilyevich,

1, Semashko str., Stavropol, 355029 .



L. V. Rozhchenko
Polenov Neurosurgery Institute – the branch of Almazov National Medical Research Centre 12, Mayakovskogo str., St. Petersburg, 191025
Russian Federation

Rozhchenko Larisa Vitalievna,

12, Mayakovskogo str., St. Petersburg, 191025.



O. S. Belokon
Stavropol regional clinical hospital
Russian Federation

Belokon Oleg Sergeevich,

1, Semashko str., Stavropol, 355029.



V. V. Eliseev
Stavropol regional clinical hospital
Russian Federation

Eliseev Vladimir Victorovich,

1, Semashko str., Stavropol, 355029. 



E. A. Grishko
Stavropol regional clinical hospital; North-Caucasus Federal University
Russian Federation

Grishko Elena Anatolyevna,

1, Semashko str., Stavropol, 355029;
1, Pushkina str., Stavropol, 355017.



K. A. Samochernykh
Polenov Neurosurgery Institute – the branch of Almazov National Medical Research Centre
Russian Federation

Samochernykh Konstantin Aleksandrovich,

 12, Mayakovskogo str., St. Petersburg, 191025.
 



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For citations:


Kornev A.P., Ermakov S.V., Rozhchenko L.V., Belokon O.S., Eliseev V.V., Grishko E.A., Samochernykh K.A. Short-term and long-term results of surgical treatment of ruptured tiny cerebral aneurysms: predictors of adverse outcomes. Russian Neurosurgical Journal named after Professor A. L. Polenov. 2024;16(1):32-43. (In Russ.) https://doi.org/10.56618/2071-2693_2024_16_1_32. EDN: AZMKUS

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