Effects of Ultra-Early and Early Treatment in Aneurysmatic Subarachnoid Hemorrhage: Single Center Retroprospective Study

Abstract

Aim:There are on going disagreements about when to perform surgical treatment for aneurysmal subarachnoid hemorrhage (aSAH), which is caused by limitations related to the disease. There is a lot of research on this topic. However, it is stil lunclear which of the two treatment options (endovascular therapy (EVT) or surgical therapy (CT)) is superior, despite studies that suggest early and ultra-earlysurgery as effective options. Material and Methods: This retrospective study was carried out on 50 patients diagnosed with aSAH and treated at Trabzon Kanuni Training and Research Hospital Brain and Nerve Surgery Clinic between June 2021 and June 2022. In this study, all patients, regardless of their treatment method (EVT or CT), were divided into two groups based on the timing of their surgery: ultra-early treatment (Group 1), where patients were treated with int he first six hours of bleeding, and early treatment (Group 2), where patients were treated between six and twenty-four hours. Results: Of the 50 patients diagnosed with aSAH and treated with EVT or CT, 31 were male (62%) and 19 were female (38%). Group 1 consists of a total of 26 patients, 14 with EVT and 12 with CT; Group 2 consists of a total of 24 patients, 13 with EVT and 11 with CT. If patients in Group 1 and Group 2 were treated with either EVT or CT, it was observed that there was no statistical superiority to each other in terms of the type and timing of treatment (p=0.678, p=0.680, respectively). Conclusion: This study did not show that there was no difference in the outcomes of both interventions (EVT or CT) performed both in the early and ultra-early period in patients diagnosed with aSAH, regardless of clinical grade.

Keywords

• Subarachnoid hemorrhage
• early surgery
• ultra-early surgery
• endovascular treatment
• cerebral aneurysm surgery

Anevrizmatik Subaraknoid Kanamada Ultra-Erken ve Erken Tedavinin Etkileri: Tek Merkezli Retroprospektif Çalışma

Abstract

Amaç: Anevrizmal subaraknoid kanamaların (aSAK) cerrahi tedavisinin zamanlaması konusundaki fikir ayrılıkları günümüzde hâlen devam etmektedir. Bu tartışmaya hastalığa bağlı sınırlamaların sebep olduğu aşikâr olup; konuya yönelik çok sayıda araştırma mevcuttur. Bu çalışmalar özellikle erken ve ultra erken cerrahiyi desteklemekle beraber; sonuçlar bu iki zamanlama içindeki tedavi seçeneklerinden hangisinin (endovasküler tedavi (EVT) veya cerrahi tedavi (CT)) üstün olduğu konusunda da henüz net değildir. Gereç ve Yöntemler: Bu çalışma, Trabzon Kanuni Eğitim Araştırma Hastanesi Beyin ve Sinir Cerrahisi Kliniğinde Haziran 2021 ile Haziran 2022 tarihleri arasında, aSAK tanısı ile tedavi edilen 50 hasta üzerinde retroprospektif olarak yapılmıştır. Hastalar çalışmamızda tedavi yöntemine bakılmaksızın (EVT veya CT) kanamanın ilk altı saat içinde tedavi edilenler ultra erken tedavi (Grup 1) ve altı saat-yirmi dört saat arasında tedavi edilenler erken tedavi (Grup 2) olmak üzere iki ayrı gruba ayrıldı. Bulgular: aSAK tanısıyla EVT veya CT ile tedavi edilen 50 hastanın 31’i erkek (%62) ve 19’u kadın (%38) idi. Grup 1, 14’ü EVT ve 12’si CT ile olmak üzere toplam 26 hastadan; Grup 2 ise 13’ü EVT ve 11’i CT ile olmak üzere toplam 24 hastadan oluşmaktadır. Grup 1 ve Grup 2’deki hastalara gerek EVT gerekse CT ile tedavi uygulanması durumunda istatistiksel olarak tedavinin tipi ve zamanlaması açısından birbirine üstünlüğü olmadığı görülmüştür (Sırasıyla p=0,678, p=0,680). Sonuç: Bu çalışma, aSAK tanılı hastaların klinik derecesine bakılmaksızın hem erken hem de ultra erken dönemde yapılan her iki müdahalenin (EVT veya CT) sonuçları açısından farklılık olmadığını göstermemiştir.

Keywords

• Subaraknoid kanama
• erken cerrahi
• ultra-erken cerrahi
• endovasküler tedavi
• serebral anevrizma cerrahisi

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