Predictors of outcome following interventions for ruptured intracranial aneurysms in an emerging health institution in West Bengal: A 6-year experience

Enoch Uche; Mesi Matthew; Sujeet Meher; Laxmi Tripathy; Wilfred Mezue; Harsh Jain; Sunandan Basu; Mark Chikani; Ephraim Onyia; Izuchukwu Iloabachie

doi:10.4103/ajns.AJNS_275_20

Asian Journal of Neurosurgery, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(02): 264-270
DOI: 10.4103/ajns.AJNS_275_20

Original Article

Predictors of outcome following interventions for ruptured intracranial aneurysms in an emerging health institution in West Bengal: A 6-year experience

Enoch Uche

¹Department of Surgery, University of Nigeria Teaching Hospital, Enugu

,

Mesi Matthew

¹Department of Surgery, University of Nigeria Teaching Hospital, Enugu

²Department of Neurosurgery, Medica Institute of Neurological Diseases, Medica Super Specialty Hospital, Kolkata

,

Sujeet Meher

²Department of Neurosurgery, Medica Institute of Neurological Diseases, Medica Super Specialty Hospital, Kolkata

,

Laxmi Tripathy

²Department of Neurosurgery, Medica Institute of Neurological Diseases, Medica Super Specialty Hospital, Kolkata

,

Wilfred Mezue

¹Department of Surgery, University of Nigeria Teaching Hospital, Enugu

,

Harsh Jain

²Department of Neurosurgery, Medica Institute of Neurological Diseases, Medica Super Specialty Hospital, Kolkata

,

Sunandan Basu

²Department of Neurosurgery, Medica Institute of Neurological Diseases, Medica Super Specialty Hospital, Kolkata

,

Mark Chikani

¹Department of Surgery, University of Nigeria Teaching Hospital, Enugu

,

Ephraim Onyia

¹Department of Surgery, University of Nigeria Teaching Hospital, Enugu

,

Izuchukwu Iloabachie

¹Department of Surgery, University of Nigeria Teaching Hospital, Enugu

› Institutsangaben

Abstract

Background: Microsurgical clipping and endovascular coiling have remained over the past half-century, the main options for definitive treatment of ruptured intracranial aneurysms. However, recent advances in endovascular techniques have broadened their application stimulating much debate regarding the usefulness of microsurgical options. For locations with limited capacity or evolving endovascular service, however, microsurgical treatment offers not only cost-effective and durable options but also oftentimes the only option available for most patients. Materials and Methods: This was a single institution questionnaire-based retrospective study from West Bengal India. It was performed on patients with aneurysmal rupture managed from June 2010 to October 2016. Data analysis was performed with SPSS for Windows, version 21. Results: One hundred and ten patients were studied. The mean age was 50.8 years (standard deviation [SD] ±13.5) for females and 50.2 (SD ± 12.4) for males (P = 0.8112, t-test). Ninety (81.8%) patients received microsurgical clipping. Microsurgical options such as wrapping, bypass, and excision were performed for 9 (8.2%) patients. Coiling was performed for 11 (10%) patients. ACOM was the most common site for ruptured aneurysm. Ictus-intervention interval (χ₂ = 10.034, P = 0.007) and multiple surgical procedures (χ₂ = 8.9341, P = 0.003) were the significant outcome determinants. Overall, 72.7% of those treated had a good outcome (Glasgow Outcome Score of 4 and 5). The good outcome was higher among microsurgery groups (73.7%) compared to the coiling group (63.6%) but this difference did not achieve statistical significance (χ₂ = 0.46 P = 0.4976). Conclusion: Microsurgical options achieved good outcomes in the management of ruptured aneurysms in our series. Their availability makes them first-line options for low-income settings.

Key-words:

Aneurysmal subarachnoid hemorrhage - endovascular technique - microsurgery - outcome

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Referenzen

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