Removal of clots in subarachnoid space could reduce the vasospasm after subarachnoid hemorrhage.

BACKGROUND: Cerebral vasospasm after subarachnoid hemorrhage (SAH) is a major cause of morbidity and mortality. We studied the effects of clot removal on multiple outcome variables following the clipping of ruptured anterior communicating aneurysms. METHODS: From 2007 to 2011, 30 patients with Fisher grade III aneurysmal SAH underwent clipping of an anterior communicating artery aneurysm before SAH day 3. There were 20 women and 10 men, mean age 53.4, range 28-80 years. Seventeen underwent fenestration of lamina terminalis and cisternal removal of clots (group A), and 13 did not (Group B). We compared clinical grades, presence of hydrocephalus at admission, treatment modality, occurrence of clinical vasospasm, the need for interventional vasospasm therapy, and need for ventriculoperitoneal shunting. FINDINGS: Vasospasm affected 5 of 17 (29%) in group A and 8 of 13 (61.5%) in group B (p < 0.05). Endovascular treatment for vasospasm was required in one patient in group A (5.8% of 17, 20% of 5) and in five from group B (38.4% of 13, 62.5% of 8) (p < 0.05). Mortality was observed in one case in group A (5.8% of 17, 20% of 5) and in two cases in group B (15.3% of 13, 25% of 8) and was related to vasospasm after SAH. Ventriculoperitonal shunt (VPS) was required in one case in group A (5.8%) and in five cases in group B (38.4%). CONCLUSIONS: Fenestration of the lamina terminalis and removal of cisternal clots significantly decreased the incidence of post-SAH hydrocephalus and was associated with better outcomes in our series.

Tratamento cirúrgico dos aneurismas intracranianos em idosos / Surgical treatment of intracranial aneurysms in elderly

Há cerca de vinte anos, pacientes idosos com diagnóstico de aneurisma cerebral eram excluídos de quaisquer modalidades de intervenção cirúrgica devido ao prognóstico reservado. Com o rápido envelhecimento da população, houve um aumento consistente na prevalência de hemorragia subaracnóide, associada a todas as suas complicações. A deterioração neurológica tardia, advinda do vasoespasmo cerebral, é uma das principais causas de morbi-mortalidade nesse grupo de pacientes. Dessa forma, a estratégia de tratamento específico para aneurismas cerebrais em idosos tem sido aprimorada.