Microsurgical treatment of severe aneurysmal subarachnoid hemorrhage: an analysis of 14 cases

Objective To analyze the therapeutic effect of microsurgery on patients with severe aneurysmal subarachnoid hemorrhage (SaSAH). Methods A retrospective analysis was conducted on 14 SaSAH patients admitted to Beijing Chao-Yang Hospital, Capital Medical University from December 2017 to November 2019. General information, Hunt Hess grading, Glasgow Coma Scale (GCS), time of rebleeding, surgery time, examination method, aneurysm size, prognosis, and postoperative follow-up were collected. Results A total of 14 patients with SaSAH were enrolled, including 5 males and 9 females, 8 patients with Hunt-Hess grade Ⅳ and 6 with grade Ⅴ. Seven cases experienced rebleeding after admission, with an average time between the onset of symptoms and rebleeding being 11.21 hours. Intracranial aneurysm rupture was confirmed by computed tomography angiography (CTA) or digital subtraction angiography (DSA) before operation in 13 cases. All 14 patients underwent microsurgical aneurysm clipping after definite diagnosis. There were 5 cases of transtentorial herniation and 3 cases of subfalcine herniation. Bone flaps were removed during surgery for all patients with cerebral herniation. In 14 cases, Glasgow prognostic score (GOS) was 4 in 2 cases, 3 in 3 cases, 2 in 7 cases, and 1 in 2 case at 6 months follow-up. Conclusion Treating SaSAH responsible aneurysms within 24 hours is an important principle for preventing intracranial rebleeding, reducing mortality, and improving prognosis. Microsurgery remains an important method for treating SaSAH, especially for patients with intracranial hematoma and progressive intracranial hypertension."