Treatment of severe subarachnoid haemorrhage -440 cases clipping versus coiling

ABSTRACT

We reviewed the ruptured cerebral aneurysm treatment in Fujita Health University Hospital with multimodalities of treatment. Form 1996 to 2002, cerebral aneurysms were treated by two methods: direct microsurgical clipping and endovascular coiling. Both were selected based on definite guidelines of clinico-radiological criteria as follows endovascular therapy comprised of GDC embolisation and CSF washout with UK or TPA performed in cases with Hunt and Kosnik grade 4 [GCS 7,8], and grade 5 [without hydrocephalus or intracranial haemorrhage], age > 70 years, subacute stage [4-14 days of vasospasm], basilar aneurysm and peripheral MCA/PCA aneurysms. Microsurgical clipping with drainage procedure was performed in cases with Hunt and Kosnik grade 0-3, grade 4 [GCS 9-12], age less than 70 years, grade 5 with hydrocephalus or intracerebral haematoma and acute stage [0-3 days after bleed]. The patient's outcome was measured using Glasgow Outcome Score [GOS] at the time of discharge. In our series of severe [poor grade] SAH cases, 120 cases underwent clipping and 59 cases underwent coiling. Though they accounted for 37.8% and 48% of total SAH cases respectively, the outcome was satisfactory. In each treatment modality, a favourable outcome [good recovery/moderate disability] was found in 75.4% of clipping cases and 55.2% of coiling cases clipping had a better outcome than coiling in cases of acute severe SAH in our series and is in contrast to ISAT results: