Document Detail


The effect of clipping and coiling in acute severe subarachnoid hemorrhage after international subarachnoid aneurysmal trial (ISAT) results.
MedLine Citation:
PMID:  16172968     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Cerebral aneurysms are treated by two methods: direct microsurgical clipping and endovascular coiling. Both are selected based on definite guidelines for clinicoradiological criteria as follows: Endovascular therapy comprising of GDC embolization, CSF wash-out with UK or TP A were performed in cases with Hunt and Kosnik grade 4 (GCS 7, 8), and grade 5 (without hydrocephalus or intracranial hemorrhage), age>70 years, subacute stage (4--14 days of vasospasm), basilar aneurysm and peripheral MCA/PCA aneurysms. Microsurgical clipping with a drainage procedure was performed in cases with Hunt and Kosnik grades 0--3, grade 4 (GCS 9--12), age less than 70 years, grade 5 with hydrocephalus or intracerebral hematoma and acute stage (0--3 days after bleed). The patient's outcome was measured using GOS (Glasgow outcome score) at the time of discharge. In our series of severe (poor grade) SAH cases, 120 cases underwent clipping and 59 cases underwent coiling. Although they accounted for 37.8 % and 48 % of total SAH cases, respectively, the outcome was satisfactory. Good recovery and moderate disability, together termed "favorable outcome" was found in 69.16 % of clipping cases and 44.06 % of coiling cases. Clipping had a better outcome than coiling in cases of acute severe SAH in our series. The golden hour resuscitation, pre-hospital care and the adjunctive treatment strategies like hypothermia are discussed. A critical appraisal of the ISAT of microsurgical clipping versus coiling is used for comparison of our results.
Authors:
Y Kato; H Sano; P T Dong; N Panji; Y Itezawa; J Hayashi; T Kanno
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Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Minimally invasive neurosurgery : MIN     Volume:  48     ISSN:  0946-7211     ISO Abbreviation:  Minim Invasive Neurosurg     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-09-20     Completed Date:  2005-12-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9440973     Medline TA:  Minim Invasive Neurosurg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  224-7     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Fujita Health University, Toyoake, Aichi, Japan. kyoko@fujita-hu.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adult
Aged
Endoscopy / methods*
Glasgow Coma Scale
Humans
International Cooperation*
Microsurgery / instrumentation*
Middle Aged
Neurosurgical Procedures / methods
Severity of Illness Index
Subarachnoid Hemorrhage / surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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