2020 Volume 48 Issue 5 Pages 321-327
As the aging of society advances and intravascular treatment progresses, we reconsidered the role of craniotomy for patients with subarachnoid hemorrhage (SAH) due to ruptured cerebral aneurysm.
Materials and Methods: A total of 512 patients (age range, 29-96 years; 361 women) with SAH were treated in the last 10 years at our institution. Severity, treatment, outcome, and complications, among other factors were examined in all cases and in radical treatment cases (n=465). The patients were divided into two groups by period, 2007-2011 (n=247) and 2012-2016 (n=265). Craniotomy was the firstline treatment in the first period, but the indications for endovascular treatment expanded in the second period.
Results: Over the course of 10 years, there has been significant progress in the aging of society. Although the distribution of disease severity did not change, the proportion of patients with comorbidities (existing disabilities and complications involving other organs) increased significantly. On multivariate analysis, age, cerebral infarction due to vasospasm, disease severity, and comorbidity were predictors of unfavorable outcomes (modified Rankin scale score 3-6) at discharge.
When the first and second periods were compared, the percentage of patients who underwent endovascular treatment increased from 6.5% to 20%. The frequency of surgical complications was not significantly different between the two periods, at approximately 25%. The overall rate of unfavorable outcomes was unchanged. The outcome was well maintained regardless of aging because patients with comorbidities were mainly treated endovascularly.
Conclusions: The role of endovascular treatment for SAH is increasing. Safety and robustness should be considered when determining which treatment modality should be selected for a particular aneurysm.
