CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2020; 39(02): 095-100
DOI: 10.1055/s-0040-1709202
Original Article |Artigo Original
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Ultra-Early Versus Early Aneurysm Surgery After Subarachnoid Hemorrhage: A Retrospective Outcome Analysis

Tratamento cirúgico precoce versus ultra precoce de aneurismas cerebrais: Análise retrospectiva
1  Faculty of Medicine, University of Coimbra, Coimbra, Portugal
2  Vila Nova de Gaia/Espinho Hospital Centre, Vila Nova de Gaia, Portugal
,
3  Neurosurgery Department, Coimbra Hospital and University Centre, Coimbra, Portugal
,
1  Faculty of Medicine, University of Coimbra, Coimbra, Portugal
3  Neurosurgery Department, Coimbra Hospital and University Centre, Coimbra, Portugal
,
3  Neurosurgery Department, Coimbra Hospital and University Centre, Coimbra, Portugal
,
4  School of Technology and Management, Polytechnic Institute of Viseu, Viseu, Portugal
,
4  School of Technology and Management, Polytechnic Institute of Viseu, Viseu, Portugal
,
1  Faculty of Medicine, University of Coimbra, Coimbra, Portugal
3  Neurosurgery Department, Coimbra Hospital and University Centre, Coimbra, Portugal
5  Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Portugal
› Author Affiliations
Further Information

Publication History

27 December 2019

18 February 2020

Publication Date:
27 April 2020 (online)

  

Abstract

Object The timing of definitive management of ruptured intracranial aneurysms has been the subject of considerable debate, although the benefits of early surgery (until 72 hours postictus) are widely accepted. The aim of the present study is to evaluate the potential benefit of ultra-early surgery (until 24 hours) when compared with early surgery, in those patients who were treated by surgical clipping at the Neurosurgery Department of the Coimbra Hospital and University Centre.

Methods A 17-year database of consecutive ruptured and surgically treated intracranial aneurysms was analyzed. Outcome was measured by the Glasgow Outcome Scale (GOS). Baseline characteristics were analyzed by the Fisher exact test, the chi-squared and Mann-Whitney tests. Logistic regression was used to assess the impact of good grade according to the World Federation of Neurological Surgeons (WFNS) scale and ultra-early surgery in a good GOS outcome.

Results 343 patients who were submitted to surgical clipping in the first 72 hours post-ictus were included, 165 of whom have undergone ultra-early surgery. Demographics and preoperative characteristics of ultra-early and early surgery patients were similar. Good-grade patients according to the WFNS scale submitted to ultra-early surgery demonstrated an improved GOS at discharge and at 6 months. Poor-grade patients according to the WFNS scale submitted to ultra-early surgery demonstrated an improved GOS at discharge.

Conclusions Ultra-early surgery for aneurysmal subarachnoid hemorrhage patients improves outcome mainly on good-grade patients. Efforts should be made on the logistics of emergency departments to consider achieving treatment on this timeframe as a standard of care.

Resumo

Objetivos O timing de tratamento dos aneurismas intracranianos rotos tem sido objeto de debate considerável, embora os benefícios da cirurgia precoce (até 72 horas após ictus) sejam amplamente aceitos. O objetivo do presente estudo é avaliar o potencial benefício da cirurgia ultra precoce (até 24 horas) sobre a cirurgia precoce nos pacientes tratados por abordagem cirúrgica no Departamento de Neurocirurgia do Centro Hospitalar e Universitário de Coimbra.

Métodos Foi usada uma base de dados de 17 anos de aneurismas intracranianos que sofreram rotura e que foram tratados cirurgicamente. O resultado foi avaliado pela Escala de Glasgow de desfecho (GOS, na sigla em inglês). As características da população foram analisadas pelo teste de Fisher, qui-quadrado e Mann-Whitney. A regressão logística foi usada para avaliar o impacto do bom estado clínico à admissão (World Federation of Neurological Surgeons [WFNS]) e da cirurgia ultra precoce sobre o bom desfecho (GOS).

Resultados Foram incluídos 343 pacientes submetidos a clipagem cirúrgica nas primeiras 72 horas pós-ictus, 165 dos quais foram submetidos a cirurgia ultra precoce. As características demográficas e pré-operatórias dos pacientes submetidos a cirurgia ultra precoce e precoce foram semelhantes. Pacientes com bom WFNS submetidos a cirurgia ultra precoce demonstraram melhoria do desfecho na alta e aos 6 meses. Os pacientes com WFNS de baixo grau submetidos a cirurgia ultra precoce demonstraram melhoria do desfecho na alta.

Conclusões A cirurgia ultra precoce para pacientes com hemorragia subaracnoidea aneurismática melhora o resultado principalmente em pacientes com bom estado clínico à admissão (WFNS). Esforços devem ser feitos na logística dos departamentos de emergência, a fim de considerar o tratamento nesse período como timing preferencial.

Ethical Approval

Ethical approval was obtained from the Coimbra Hospital and University Centre ethical commission.


* Dr. António Canotilho Lage and Dr. Miguel T. Carvalho contributed equally to this research and should be considered as joint first authors.