Anesthesia, complications, and clinical outcome for ruptured intracranial aneurysms: a retrospective comparison between endovascular coiling and neurosurgical clipping

Authors: VLADIMIR VRSAJKOV, RADMILA KOLAK, ANNA URAM-BENKA, ARSEN UVELIN, JASENKA KISELICKI

Abstract: To compare anesthetic practice, perioperative complications, and clinical outcomes of endovascular coiling versus neurosurgical clipping in our university hospital over a 2-year period. Materials and methods: This was a retrospective review of the hospital charts of 30 patients with cerebral aneurysms treated by endovascular coiling compared with 52 patients treated by neurosurgical clipping. Information including demographics, preoperative neurological status, timing of intervention, anesthetic management, duration of the postoperative intensive care and hospital stay, intra- and postoperative complications, and clinical outcome at hospital discharge were compared and analyzed. P < 0.05 was considered to be significant. Results: The surgical group had greater consumption of certain anesthetic agents whereas the endovascular group had more frequent episodes of hypertension (>30% more than the baseline measurement) during the procedure. We recorded significantly longer durations of stay in the intensive care unit for surgical patients. Clinical outcome at discharge was significantly better in patients treated with endovascular coiling (P = 0.004). There were significantly more cases of hyponatremia (Na < 135 mmol/L) in the surgical group. Conclusion: Compared with neurosurgical clipping, endovascular coiling was associated with significant benefits in terms of reduced consumption of anesthetics, stay in the intensive care unit, and perioperative complications, as well as a better clinical outcome.

Keywords: Subarachnoid hemorrhage, anesthesia, intracranial aneurysm, coiling, clipping

Full Text: PDF