Comparison of Surgical Treatment and Endovascular Treatment of Intracranial Aneurysms

Year 2018, Volume: 10 Issue: 3, 76 - 82, 01.12.2018

İbrahim Alataş Hüseyin Canaz

Abstract

Aim: We imed to comparison of endovascular and surgical treatment in patients with subarachnoid hemorrhage. Materials and Methods: 86 patients who applied our emergency service with subarachnoid hemorrhage, were classified according to their age, gender, risk factors, symptoms, localization of aneurysms, having single or multiple aneurysms and Fischer index. Results of surgical and endovascular treatment were evaluated due to time of intervention and Glaskow Coma Scale. Neurologic status of patients evaluated according to Hunt-Hess scale and World Federation of Neurosurgical Societies WFNS grading system at the time of application. The outcome of the patients defined with Glaskow Coma Scale. Results: Result of surgery was better in patients who needed emergency intervention and operated between 24 hours and 5 days. Results of endovascular treatment were better in patients with stable neurological status, low grade Hunt-Hess scale, aneurysms with perforating branches. Conclusion: Although endovascular treatment reduces the morbidity and mortality with developing technology and techniques, surgery is still the first choice in patients who need urgent intervention.

Keywords

Cerebral aneurysms, Endovascular treatment, Surgical treatment

İntrakranial Anevrizmalarda Cerrahi Tedavi ile Endovasküler Tedavinin Karşılaştırılması

Abstract

Amaç: Acil servisimize başvuran ve anevrizmal subaraknoid kanama SAK tanısı alan hastaların cerrahi ve endovasküler tedavilerinin verilerinin karşılaştırılması amaçlanmıştır. Gereç ve Yöntem: Acil servisimize direk başvuran SAK’ı bulunan veya klinik olarak anevrizma şüphesi bulunan 86 hasta yaş, cinsiyet, risk fatörleri, geliş klinik semptomları, anevrizma lokalizasyonları, tek veya birden fazla anevrizmaya sahip oluşuna, Fischer indeksine göre gruplandırıldı. Cerrahi ve endovasküler tedavilerinin sonuçları girişim zamanına ve Glaskow Koma Skoruna GKS göre değerlendirildi. Vakaların geliş nörolojik tabloları ‘Hunt-Hess’ ve ‘World Federation of Neurosurgical Societies’ WFNS grade’ine göre, klinikten çıkış durumları ise GKS’ye göre değerlendirildi. Bulgular: Acil girişim gerektiren durumlarla beraber 24 saat-5 gün arası cerrahi sonuçlarını daha iyi saptadık. Nörolojik tablosu stabil, grade iyi olan hastalarda; cerrahi uygulanması zor, perforan dalları mevcut olan anevrizmalarda da 5-15 günler arası endovasküler tedavinin sonuçlarını daha iyi bulduk. Sonuç: Daha da ilerleyen teknoloji ve endovasküler tekniklerle daha yüksek sağ kalım ve düşük morbidite oranlarının endovasküler girişim lehine değişeceği kanısında olsak da, acil durumlarda cerrahi girişimin her zaman ilk tercih olması düşüncesindeyiz.

Keywords

Cerrahi tedavi, Endovasküler tedavi, Serebral anevrizma

References

• 1. Osborn AG. Diagnostic Neuroradiology. Mosby 1994.
• 2. Meyer FB, Morita A, Puumala MR, Nichols DA.Medical and surgical management of intracranial aneurysms. Mayo Clinic proceedings 1995; 70: 153- 172
• 2. Solomon RA, Fink ME, Pile-Spellman J Surgical management of unruptured intracranial aneurysms. J Neurosurg 1994; 80: 440-446
• 4. Mohr JP (2004) Stroke: Pathophysiology, Diagnosis, and Management. Churchill Livingstone
• 5. Canbaz B, Akar Z, Özçınar G, Kuday C, Sayın E, Sarıoğlu Aç, Özyurt E, Ak H (1992) 251 Opere İntrakranial Anevrizma Olgusu. Türk Nöroşirürji Dergisi 2: 161-164
• 6. Övül İ (1997) Subaraknoid kanama (SAK). In: Altınörs N, Baykaner K, Şekerci Z, Özyurt E, Caner H (eds) Temel Nöroşirürji, Ankara, pp 1-18
• 7. Hacıyakupoğlu S (1997) Subaraknoid Kanamanın Medikal Tedavisi. In: Altınörs N, Baykaner K, Şekerci Z, Özyurt E, Caner H (eds) Temel Nöroşirürji, Ankara, pp 1-32
• 8. Yaşargil MG (1984) Middle Cerebral Artery Aneursym. In: Yaşargil MG (ed) Microneurosurgery. Thieme Stratton, Stuttgard, pp 124-164
• 9. Arda MN (1997) Dev Anevrizmalar. In: Altınörs N, Baykaner K, Şekerci Z, Özyurt E, Caner H (eds) Temel Nöroşirürji, Ankara, pp 1-16
• 10 Yaşargil MG (1984) Giant Intracranial Aneursyms. In: Yaşargil MG (ed) Microneurosurgery. Thieme Stratton, Stuttgard, pp 296-304
• 11. Yaşargil MG (1984) Microneurosurgery. Thieme Stratton, Stuttgard
• 12. Ünal F, Döşoğlu M, Önal SÇ, Orakdöğen M, Çoban O, Turantan Mİ, Kaya U (1992) Kafa içi multipl anevrizmalar. Türk Nöroşirürji Dergisi 4: 273-278
• 13. Yaşargil MG (1984) Multiple Aneursyms. In: Yaşargil MG (ed) Microneurosurgery. Thieme Stratton, Stuttgard, pp 273-278
• 14. Cesarini KG, Hårdemark H-G, Persson L (1999) Improved survival after aneurysmal subarachnoid hemorrhage: review of management during a 12-year period. Journal of neurosurgery 90: 664-672
• 15. Kassell NF, Torner JC, Haley Jr EC, Jane JA, Adams HP, Kongable GL, Participants (1990) The International Cooperative Studyon the Timing of Aneurysm Surgery: Part 1: Overall management results. Journal of neurosurgery 73: 18-36
• 16. Deruty R, Mottolese C, Pelissou-Guyotat I, Soustiel J (1991) Management of the ruptured intracranial aneurysm-early surgery, late surgery, or modulated surgery? Acta neurochirurgica 113: 1-10
• 17. Ljunggren B, Brandt L, Kågström E, Sundbärg G (1981) Results of early operations for ruptured aneurysms. Journal of neurosurgery 54: 473-479
• 18. Ebeling U, Reulan HC (1985) Cerebral Vasospasm and Aneursyms Surgery a Review. In: Auer ML (ed) Timing of aneurysm surgery. De Gruyter, Berlin, pp 412-417
• 19. Friedric H, Serfert V, Stoloke D (1985) Experience in Aneursyms Surgery; Early Versus Late Surgery. In: Auer ML (ed) Timing of aneurysm surgery. De Gruyter, Berlin, pp 133-141
• 20 Da Pion R, Pasqualin A, Screnza R, Cavazzani P (1985) Early Surgery for Intracranial Aneursyms: Influence of Clinical and Operative Finding on Final Results. In: Auer ML (ed) Timing of aneurysm surgery. De Gruyter, Berlin, pp 115-123
• 21. Canbolat A, Bozboga M, Hamamcioglu M (1994) Erken Anevrizma Cerrahisi. Tıp Fakültesi Mecmuası 57: 23-31
• 22. Fisher CM, Kistler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6: 1-9
• 23. Sahs AL (1974) Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage. Report on a Randomized Treatment Study. Stroke 5: 550-551
• 24. Le Roux PD, Elliot JP, Newell DW, Grady MS, Winn HR (1996) The incidence of surgical complications is similar in good and poor grade patients undergoing repair of ruptured anterior circulation aneurysms: a retrospective review of 355 patients. Neurosurgery 38: 887-893; discussion
• 25. Lafuente J, Maurice-Williams RS. Ruptured intracranial aneurysms: the outcome of surgical treatment in experienced hands in the period prior to the advent of endovascular coiling. Journal of neurology, neurosurgery, and psychiatry 2003;74: 1680-1684
• 26. Vinuela F, Duckwiler G, Mawad M Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 1997; 86: 475- 482
• 27 Ross IB, Weill A, Piotin M, Moret J. Endovascular treatment of distally located giant aneurysms. Neurosurgery 2000;47: 1147-1152.
• 28. Molyneux A, Kerr R, Stratton I, Sandercock P, Clarke M, Shrimpton J, Holman R, International Subarachnoid Aneurysm Trial Collaborative G. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial. Lancet 2002; 360: 1267-1274.
• 29. International Study of Unruptured Intracranial Aneurysms I. Unruptured intracranial aneurysms--risk of rupture and risks of surgical intervention. The New England journal of medicine 1998;339: 1725-1733.