Improved outcome in high-grade aneurysmal subarachnoid hemorrhage by enhancement of endogenous clearance of cisternal blood clots: a prospective study that demonstrates the role of lamina terminalis fenestration combined with modern microsurgical cisternal blood evacuation

Minimally Invasive Neurosurgery : MIN
J MuraJ J Marengo

Abstract

Cisternal and ventricular blood predisposes to hydrocephalus and cerebral ischemia after high-grade aneurysmal subarachnoid hemorrhage (HGSAH). We studied the role of lamina terminalis fenestration combined with cisternal blood evacuation in HGSAH. A clinical, prospective, non-randomized study of a series of HGSAH patients (Modified Fisher>or=3) treated in the acute phase was carried out. The microsurgical treatment included aneurysm clipping, cisternal blood evacuation, and fenestration of the lamina terminalis. A comparable, non-blood-cleansed, endovascular-treated group, was included as a control. Clinical results were evaluated by the Glasgow Outcome Scale (GOS). During a period of 30 months, 95 patients who met the selection criteria were treated by microsurgical procedures and 28 by endovascular procedures. The distribution of GOS scores was superior for the microsurgical group: good results (GOS 4-5) were obtained in 85.3%, with a mortality rate of 5.9%. By contrast, 60.3% of patients in the endovascular group achieved GOS 4-5 scores, and 15.8% died. Good results for the endovascular group correlated inversely with delay of treatment. A permanent ventriculo-peritoneal shunt was necessary in 3.2% and 7.1% of the microsurg...Continue Reading

Citations

Mar 16, 2013·Surgical Neurology International·Jorge Marcelo MuraEvandro de Oliveira
May 20, 2014·Journal of Neurosurgery·Francesco TomaselloAlfredo Conti
Mar 1, 2012·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·Jingjing LuXingquan Zhao
Mar 14, 2016·Clinical Neurology and Neurosurgery·Sang-Bae KoKiwon Lee
Dec 17, 2014·Critical Care Medicine·Yogesh Moradiya, Wendy Ziai
Aug 3, 2017·The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques·Muhammad Omar ChohanHoward Yonas
Nov 18, 2020·Neurocritical Care·Christopher MelinoskyNicholas A Morris
Jun 3, 2021·International Journal of Molecular Sciences·Lu-Ting Kuo, Abel Po-Hao Huang

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