Surgical Management of Aneurysmal Subarachnoid Haemorrhage in the Punjab Institute of Neuroscience (PINS) Decade and Need of Shunt for Hydrocephalus
Keywords:
CSF: Cerebrospinal Fluid, CT: Computed Tomography, DCI: Delayed Cerebral Ischemia, MCA: Middle Cerebral ArteryAbstract
Objective: Aneurysmal Subarachnoid Haemorrhage management is improving with the passage of time with the advancement of Microsurgery but still mortality is relatively high in the natural history of disease. The main stay of this gap is noted from the time of ictus to the time of presentation in the tertiary care centers. Management of Hydrocephalus was also studied in this study. Material and Methods: This is a prospective study conducted at PINS LGH Lahore. We studied a total of 50 cases in a period of July 2015 to July 2017. Results: Twenty nine (58.00%) were female and 21 (42.00%) male, the male to female ratio remained 1:1.5. The affected age group was mostly younger one in there productive years. Maximum patient were noted in 4th decade, equal incidence was seen in 5th and 6th decade of life. CT scan was done as initial investigation while CT angiogram and four vessels angiogram were used as definitive investigations. Grading of patient was done using the WFNS grade and 29 cases were found in good grades (58.00%). Maximum Aneurysm were founded at A.com artery 24 cases (45.00%) followed by 22 cases of middle cerebral artery (MCA) (41.00%).We predicted the vasospasm using the fisher grades and found 21 cases (42.00%) in Fisher Grade II, in grade III & IV there was 17 and 12 cases (24.00%) respectively. Surgical outcome of post clipping was analyzed by Glasgow outcome scale and 41 cases (82.00%) were present in Grade IV and V. We found in post-operative management that patent within older age had high chance to develop hydrocephalus and V-P shunt was required in 9 cases out of 28 in group of 55 – 65 years. While in younger group (52.00%) 20 – 49 years. 22 (19.00%) cases needed V-P shunt . relatively aggressive approach was used toward CSF diversion procedure in pre-clipping period 26% patient underwent ventriculoperitoneal V-P shunt (n+12). Triple therapy started in all the case post operatively to avoid vasospasm. Post-operative CT-scan was done on 1st post-operative day. Conclusion: Patients in Older Age group had higher tendency to be shunt dependent 32% vs. 19%; p-value = 0.04 (Chi Sq. test) (Table 3 & 4).
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