The effects of the early and ultra-early intervention on the outcome in aneurysmatic subarachnoid hemorrhage

BACKGROUND: The optimal timing of intervention for aneurysmatic subarachnoid hemorrhage is one of the historically controversial issues in neurosurgery. Although numerous studies investigated the subject, they had many limitations due to the nature of the disease. Early and ultra-early interventions have gained more and more supporters in recent decades. Nevertheless, the effects of the early and ultra-early intervention on the outcome of the disease are far from clarity.
METHODS: A single-center retrospective cohort study was carried out at Trakya University Medical Faculty Training and Practice Hospital. The study includes data on all patients admitted with an aneurysmal subarachnoid hemorrhage between January 1, 2001, and December 31, 2005. Patients were divided into two groups according to their WFNS grade status: Good (I–III) or poor (IV–V) grades. Patients are also classified according to their Glasgow Outcome Scale score: Unfavorable (1–2) or favorable (3–5) outcomes. Data were analyzed statistically, and the effects of the early and ultra-early intervention on the outcome were assessed.
RESULTS: A total of 580 patients were admitted in the study period. Among them, 494 were eligible for the study. The median age (interquartile range) was 55 (18) years. While 244 (49.4%) patients were women, 250 (50.6%) patients were men. Three hundred and fourteen (63.6%) patients were operated, and 25 patients (5.1%) were undergone endovascular treatment. The ultra-early intervention was achieved in 60 (12.1%) patients and 142 patients (28.7%, including the previous ultra-early intervention group) early intervention was achieved. A meaningful outcome difference was present between the poor-grade ultra-early treatment group and the rest (p=0.007). Analogously, a meaningful outcome difference was present between the poor-grade early treatment group and the rest (p<0.001).
CONCLUSION: This study supports the growing trend toward early or ultra-early intervention in aneurysmatic subarachnoid hemorrhage. Our findings showed that both early and ultra-early interventions have positive effects on the outcome in poor-grade aneurysmatic subarachnoid hemorrhage patients. Future studies with more homogenized and larger samples should be realized to clarify the optimal timing of intervention for aneurysmatic subarachnoid hemorrhage.

Erken ve ultra-erken müdahalenin anevrizmatik subaraknoid kanamada sonuç üzerine etkileri

AMAÇ: Anevrizmatik subaraknoid kanama için optimal müdahale zamanlamasý nöroþirürjide tarihsel olarak tartýþmalý konulardan biridir. Çok sayýda çalýþma konuya deðinmesine raðmen, hastalýðýn doðasý nedeniyle bu çalýþmalarýn birçok sýnýrlamalarý vardýr. Erken ve ultra-erken müdahaleler son yýllarda giderek daha fazla destekçiye ulaþmýþtýr. Bununla birlikte, erken ve ultra-erken müdahalenin hastalýðýn sondurumu üzerindeki etkileri netlik kazanmamýþtýr.
GEREÇ VE YÖNTEM: Trakya Üniversitesi Týp Fakültesi Eðitim ve Uygulama Hastanesi’nde tek merkezli geriye dönük bir kohort çalýþmasý yapýldý. Çalýþma, 1 Ocak 2001 ve 31 Aralýk 2015 tarihleri arasýnda anevrizmal subaraknoid kanama ile baþvuran tüm hastalara ait verileri içerdi. Hastalar WFNS Derecelerine göre “Ýyi Derece (I-III)” veya “Kötü Derece (IV-V)” olmak üzere iki gruba ayrýldý. Hastalar ayrýca Glasgow Sondurum Skalasý puanlarýna göre “Olumsuz (1–2)” veya “Olumlu (3–5)” sondurum olarak sýnýflandýrýldý. Veriler istatistiksel olarak analiz edilerek, erken ve ultra-erken müdahalenin sondurum üzerindeki etkileri deðerlendirildi.
BULGULAR: Çalýþma döneminde toplam 580 hasta kabul edildi. Bunlar arasýndan 494 hasta çalýþma için uygun bulundu. Ortanca yaþ (çeyrekler arasý aralýk) 55 (18) yýl idi. Ýki yüz kýrk dört hasta (%49.4) kadýn iken 250 hasta (%50.6) erkekti. Üç yüz on dört hasta (%63.6) ameliyat edildi ve 25 hastaya (%5.1) endovasküler tedavi uygulandý. Ultra-erken müdahale 60 hastada (%12.1), erken müdahale 142 hastada (%28.7) (bu grup ultra-erken müdahale grubunu da kapsamaktadýr) saðlandý. Düþük dereceli ultra erken tedavi grubu ile diðerleri arasýnda anlamlý bir sondurum farký mevcuttu (p=0.007). Benzer þekilde, düþük dereceli erken tedavi grubu ile diðerleri arasýnda anlamlý bir sondurum farký vardý (p<0.001).
TARTIÞMA: Bu çalýþma, anevrizmatik subaraknoid kanamada erken veya ultra-erken müdahaleye yönelik artan eðilimi desteklemektedir. Bulgularýmýz, hem erken hem de ultra-erken müdahalenin düþük dereceli anevrizmatik subaraknoid kanama hastalarýnda sondurum üzerinde olumlu etkileri olduðunu göstermiþtir. Anevrizmatik subaraknoid kanama için en uygun müdahale zamanýný açýklýða kavuþturmak için daha homojen ve büyük örneklerle yeni çalýþmalar gerçekleþtirilmelidir.