Diagnosis and surgical treatment for aneurysmal subarachnoid hemorrhage
- Author:
Duong Cham Uyen
- Publication Type:Journal Article
- Keywords:
Diagnosis;
Surgical treatment;
Aneurysmal subarachnoid hemorrhage
- MeSH:
Subarachnoid Hemorrhage, Therapeutics, Diagnosis
- From:Journal of Medical Research
2005;34(2):86-91
- CountryViet Nam
- Language:Vietnamese
-
Abstract:
Objective: To study the clinical presentations, diagnosis of spontaneous subarachnoid hemorrhage (SAH) due to ruptured aneurysms. Determine the operative indications, the surgical modalities and timing of operation. Evaluate the outcome of surgical treatment. Method: This study is performed in 73 patients with aneurysmal SAH, who have been underwent the surgical treatment at the Viet Duc hospital, between 1/1998 and 8/2003. 21 patients were retrospectively analyzed and the prospective evaluation has been performed in 52. The surgical outcome is followed up for a mean time of 31 months. Results: 73 patients ranged in age from 13 to 68 years (mean 44.5), with 37 womens and 36 mens.The classic symptoms and signs: severe headache 83.5%, meningeal syndrome 57.5%, deterioration of consciousness 46.6%. Seizures incidence 12.3%. 8.2% patients have a obscure clinical presentation. The overall sensitivity of CT for aneurysmal SAH was 89%. Lumbar puncture was performed on 21 patients, and revealed bloody or xanthchromia spinal fluid. Cerebral arteriography was able to detect the aneurysm on all patients. 6 hydrocephalus and 5 hematomas were operated in urgent conditions. The delayed surgery for ruptured intracranial aneurysms was indicated in 87.6% patients. Direct surgical clipping obliterated 69 aneurysms. GOS at 31 months posthaemorrhage indicated that 86.1% patients experienced good recovery. Conclusion:The clinical presentation of aneurysmal SAH was often typical. CT sacnner was a crucial diagnostic modality of SAH with high sensitivity, and cerebral arteriography was "gold standard" for diag nosis of ruptured intracranial aneurysms. The surgical treatment play an important role for hydrocephalus, intracerebral hematomas and aneurysmal obliteration. Microsurgery for clipping aneurysms was effective method, with low complication. None of the patients had a repeat hemorrhage, and 86.1% patients had a good result.
