Comparison of Clinical Results between GDC Treatment and Direct Surgery for Ruptured Cerebral Aneurysms

Abstract

We present a comparison of clinical results between GDC treatment and direct surgery for ruptured cerebral aneurysms. From May 97 to April 98, 32 aneurysms were treated by direct surgery (DS) or GDC treatment. Treatments were selected depending on the clinical grade, degree of hematoma and anatomical aspect of the aneurysms. There were 13 GDC treated cases and 19 direct surgery cases. In GDC cases, there were acute stage embolization for ruptured basilar aneurysm, recurrence of case after clipping for BA-SCA aneurysm, advanced age cases, and systemic complication cases.

Glasgow outcome scale (GOS) in GDC cases were 8 GR, 2 MD and 3 SD. GOS in direct surgery cases were 7 GR, 4 MD, 4 SD and 4 deaths. Cases of severe subarachnoid hemorrhage with hematoma influenced the high death rate in direct surgery group. There were three complications associated with the procedure in the GDC group, however, the rate improved after advancement of the procedure. In conclusion, GDC treatment for ruptured cerebral aneurysm was satisfactorily acceptable compared to the results of direct surgery, however, more cases will be needed for precise comparison.

Keywords

cerebral aneurysm GDC embolization outcome clipping

Get full access to this article

View all access options for this article.

References

Byrne

Molyneux

: Embolisation of recently ruptured intracranial aneurysms. J Neurol Neurosura Psyciatry 59: 616–620, 1995.

Duong

Kolluri

: Risk score estimation: a New method to determine optimal timing of aneurysm clipping for improved management outcome. Neurological Research 20: 218–224, 1998.

Ezura

Takahashi

: Matters to be attended to in intra-aneurysmal GDC embolization for aneurysms with no hemorrhage or hemorrhage in chronic stage. Interventional Neuroradiology 3 (Suppl 2): 154–155, 1997.

Hillman

Säveland

: Overall management outcome of ruptured posterior fossa aneurysms. J Neurosurg 85: 33–38, 1996.

Malisch

Guglielmi

: Intracranial aneurysms treated with the Guglielmi detachable coil: Midterm clinical results in a consecutive series of 100 patients. J Neurosurg 87: 176–183, 1997.

Matsumaru

Sonobe

: Embolisation of ruptured cerebral aneurysms with GDCs. Abstract of the 27th Japanese Conference on Surgery of Cerebral Stroke 1998: 146.

Mericle

Wakhloo

: Delayed aneurysm re-growth and recanalization after Guglielmi detachable coil treatment - case report. J Neurosurg 89: 142–145, 1998.

Moriyama

Matsumoto

: Progress in the management of patients with aneurysmal subarachnoid hemorrhage: a single hospital review for 20 years. Part I: Younger patients. Surg Neurol 44: 522–527, 1995.

Murayama

Malisch

: Incidence of cerebral vasospasm after endovascular treatment of acutely ruptured aneurysms: Report on 69 cases. J Neurosurg 1997.

10.

Tsuura

Terada

: Treatment of intracranial aneurysms using Guglielmi detachable coil. Abstract of the 27th Japanese Conference on Surgery of Cerebral Stroke 1998: 185.

11.

Vermeiji

Hasan

: Impact of medical treatment on the outcome of patients after aneurysmal subarachnoid hemorrhage. Stroke 29: 924–930, 1998.

12.

Viñuela

Duckwiler

: Guglielmi detachable coil embolisation of acute intracranial aneurysm: Perioperative anatomical and clinical outcome in 403 patients. J Neurosurg 86: 475–482, 1997.

13.

Yoshikai

Nagata

: A retrospective analysis of the outcomes of patients with aneurysmal subarachnoid hemorrhages: a Focus on the prognostic factors. No Shinkei Geka 24: 733–738, 1996.