Organization of Surgical Care for Patients with Aneurysmal Subarachnoid Hemorrhage in a Large Region of Russia (According to the Republic Of Tatarstan)

The Republic of Tatarstan is one of the regions of our country with successful debut of realization the program of optimisation the treatment of patients with stroke.

Objectives: to analyze the experience of this region and to determine the list of conditions necessary for successful implementation the surgical treatment of patients with aneurysmal subarachnoid hemorrhage.

Materials and Methods: results of treatment of 517 patients with aneurysmal subarachnoid hemorrhages between 2007 and 2012 were analyzed. Open surgery was performed to 201 patients, endovascular intervention to 271. The number of men and women was equal, the age dispersion was from 16 to 74 years. The surgery was performed in different time periods of SAH from 1 day to 8 years after the rupture of aneurysm with a clear tendency to perform the surgery in acute period. Most of the patients after nontraumatic SAH imaging were transferred from primary vascular centers. Patients with I-III stages of severity were operated both open and endovascular surgery, patients with severity stage higher than III were prefered for endovascular treatment.

Results: 82% of patients were discharged without any neurological deficit, 53% of them retained ability to work. 8 patients died (2%) during the observation period after surgery. Two patients died (1%) after clipping, 10 patients (3%) after endovascular interventions.

Conclusion: contribution for successful debut of the Federal program in the Republic of Tatarstan were:

• opening of 15 primary vascular centers with round-the-clock brain and its vessels visualization;

• adequate material support for performing modern neurosurgical interventions;

• continuous improvement of doctors of different specialities in stroke education;

• training of neurosurgeons in leading hospitals of Russia and abroad.