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Management of subarachnoid hemorrhage with intracerebral hematoma: clipping and clot evacuation versus coil embolization followed by clot evacuation
  1. Kenneth de los Reyes,
  2. Aman Patel,
  3. Joshua B Bederson,
  4. Jennifer A Frontera
  1. Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York, USA
  1. Correspondence to Dr Jennifer A Frontera, Neurosurgery, Mount Sinai School of Medicine, One Gustave Levy Place, Box 1136, New York, NY 10010, USA; jenfrontera{at}hotmail.com

Abstract

Background Aneurysmal subarachnoid hemorrhage (SAH) with associated intracerebral hemorrhage (ICH) is often treated with concomitant surgical clipping and ICH evacuation. The aim of this study was to determine if aneurysm coiling followed by ICH evacuation is a viable alternative treatment.

Methods A retrospective review was conducted between July 2000 and March 2009 of patients with aneurysmal SAH plus ICH (>30 ml or with midline shift >5 mm) who underwent aneurysm repair (either coiling or clipping) and craniotomy for ICH evacuation. Demographic and radiographic criteria, time to aneurysm protection, length of stay (LOS), treatment complications, discharge disposition and 3 month functional outcome were compared between groups.

Results Of 18 SAH+ICH patients, 10 underwent aneurysm coiling followed by ICH evacuation and eight underwent clipping with ICH evacuation. Compared with clipped patients, coiled patients had a lower Glasgow Coma Scale score (median 5.5 vs 7.5), higher ICH score (median 3 vs 2), worse modified Fisher score (median 4 vs 3) and higher rate of herniation at presentation (50% vs 25%). Median time to aneurysm protection was shorter in coiled patients (299 vs 885 min, p<0.001). Comparing coiled with clipped patients, rates of death (30% vs 25%), poor outcome (70% vs 50%), median ICU LOS (20 vs 22 days), median hospital LOS (27 vs 29 days) and total median direct costs ($64 537 vs $61 243) were similar, as were complication rates (all p>0.05).

Conclusions Coiling followed by ICH evacuation is associated with faster time to aneurysm protection and similar outcome, LOS and cost as clipping and evacuation. This may be a viable alternative to clipping and ICH evacuation.

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Footnotes

  • Portions of this work were presented in abstract form at the Neurocritical Care Conference, November 2009.

  • Competing interests None.

  • Ethics approval The study was approved by Mount Sinai Hospital institutional research board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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