Surgery of Arterial Aneurysms in an Acute Period of Subarachnoid Hemorrhage and External Decompression

Sazonov I., Filatov Yu., Eliava Sh., Zolotuhin S., Heyredin └., Belousova ╬., Shehtman ╬.,
Zarzur H., Sazonova ╬., Ogurtsova └., Dausheva └., Torbotryas N.

Burdenko Research Institute of Neurosurgery, Moscow, Russia

 

There were 512 cases, who had an acute stage of subarachnoid hemorrhage from cerebral aneurysms. They were treated at the Institute during 10 years. All the cases were divided into two groups. The first one comprised patients (98), subject to intraoperative or delayed external decompression. The rest cases (402) were included into the second control group.

It should be emphasized, that intraoperative external decompression is an aggressive life-saving procedure. Combined with conservative methods, it allows to increase survival of the most ôsevereö category of patients. Two groups of factors, conditioning indications for external decompression, were determined.
Absolute factors were as follows: a state, estimated as Grade V according to Hunt & Hess scale; absence of vascular autoregulation, revealed by intraoperative ultrasonic Doppler examination with a hypocapnia test; extremely marked changes, demonstrated by preoperative EEG.
Among relative factors one could mention a state, characterized by Grade III-IV (Hunt&Hess scale); reduced vascular reactivity according to data of intraoperative ultrasonic Doppler examination with a hypocapnia test; hemorrhage severity, estimated on the basis of CT data; presence of intraoperative complications; preoperative angiospasm, exceeding a critical level and revealed by transcranial Doppler; marked changes of electroencephalograms; operation, performed on the 6-9th day after hemorrhage; an age of more than 45 years.

Developed methods allowed to plan performing of external decompression an acute period of hemorrhage, which improved treatment results.