Immediate and long-term results after microsurgical clipping of ruptured aneurysms in acute period of hemorrhage

Derkach M.I.

Vladimirsky Moscow Regional Research Clinical Institute;
Russian Medical Academy for Continuous Professional Education

ORCID: 0009-0002-3618-1029

Dzhindzhikhadze R.S.

Vladimirsky Moscow Regional Research Clinical Institute;
Russian Medical Academy for Continuous Professional Education

ORCID: 0000-0003-3283-9524

Polyakov A.V.

Vladimirsky Moscow Regional Research Clinical Institute

ORCID: 0000-0001-7413-1968

Zaitsev A.D.

Vladimirsky Moscow Regional Research Clinical Institute

ORCID: 0000-0002-0987-3436

Strakhov G.Yu.

Russian Medical Academy for Continuous Professional Education

ORCID: 0000-0002-9083-9293

Lazarev V.A.

Russian Medical Academy for Continuous Professional Education

ORCID: 0000-0001-9663-0960

Immediate and long-term results after microsurgical clipping of ruptured aneurysms in acute period of hemorrhage

Authors:

Derkach M.I., Dzhindzhikhadze R.S., Polyakov A.V., Zaitsev A.D., Strakhov G.Yu., Lazarev V.A.

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Journal: Burdenko's Journal of Neurosurgery. 2024;88(5): 30‑37

DOI: 10.17116/neiro20248805130

Downloaded: 52

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To cite this article:

Derkach MI, Dzhindzhikhadze RS, Polyakov AV, Zaitsev AD, Strakhov GYu, Lazarev VA. Immediate and long-term results after microsurgical clipping of ruptured aneurysms in acute period of hemorrhage. Burdenko's Journal of Neurosurgery. 2024;88(5):30‑37. (In Russ., In Engl.)
https://doi.org/10.17116/neiro20248805130

Подписка 2025-2 (Burdenko's Journal of Neurosurgery)

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OBJECTIVE

To evaluate the immediate and long-term results after microsurgical treatment of cerebral aneurysms in acute period of hemorrhage; to analyze functional results and long-term outcomes, including higher mental functions and return to previous work.

MATERIAL AND METHODS

The study included 517 patients in acute period of subarachnoid hemorrhage between 2019 and 2022. Severity of hemorrhage was assessed using the Hunt-Hess scale while the Fisher scale was valuable to estimate dimensions of hemorrhage and predictions for vasospasm. All patients underwent microsurgical clipping of aneurysms. We assessed clinical status and outcomes immediately after microsurgical clipping, within 2 weeks, 1, 3, 6 and 12 months after surgery. The Modified Glasgow Outcome Scale, Modified Rankin Scale (mRS), EQ-5D-3L Quality of Life Questionnaire, Mini-Mental State Examination MMSE and Hamilton Anxiety Rating Scale were used.

RESULTS

After 1 month, mRS score 0 was observed in 22% of patients, score 1 — 17%, score 2 — 19.4%, score 3 — 6.2%, score 4 — 2.6%, score 5 — 1% of patients. Mortality rate was 6.4%. After 12 months, mRS score 0, 1, 2, 3 and 4 was observed in 67%, 15%, 8%, 3% and 0.4% of patients, respectively. After 12 months, 39 (8.3%) patients did not return to previous work. Among 427 (91.7%) patients who returned to previous work, 20% returned to work after 3 months, 65% after 6 months and 15% after 9 months.

CONCLUSION

Short-term and long-term functional outcomes vary significantly. There were significantly better mRS scores in long-term period compared to early period. Analysis of immediate and long-term results after hemorrhage will allow us to determine the most important predictors of adverse functional outcomes, assess the prevalence, characteristics, modifiable risk factors and consequences of hemorrhage.

Keywords:

subarachnoid hemorrhage

aneurysm rupture

microsurgical clipping

Authors:

Derkach M.I.

Vladimirsky Moscow Regional Research Clinical Institute;
Russian Medical Academy for Continuous Professional Education

ORCID: 0009-0002-3618-1029

Dzhindzhikhadze R.S.

Vladimirsky Moscow Regional Research Clinical Institute;
Russian Medical Academy for Continuous Professional Education

ORCID: 0000-0003-3283-9524

Polyakov A.V.

Vladimirsky Moscow Regional Research Clinical Institute

ORCID: 0000-0001-7413-1968

Zaitsev A.D.

Vladimirsky Moscow Regional Research Clinical Institute

ORCID: 0000-0002-0987-3436

Strakhov G.Yu.

Russian Medical Academy for Continuous Professional Education

ORCID: 0000-0002-9083-9293

Lazarev V.A.

Russian Medical Academy for Continuous Professional Education

ORCID: 0000-0001-9663-0960

Received:

13.05.2024

Accepted:

21.06.2024

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